Top

European Spine Journal

Published in:

01-11-2017 | Original Article

Pedicle screw insertion accuracy in terms of breach and reposition using a new intraoperative cone beam computed tomography imaging technique and evaluation of the factors associated with these parameters of accuracy: a series of 695 screws

Authors: Virginie Cordemans, Ludovic Kaminski, Xavier Banse, Bernard G. Francq, Christine Detrembleur, Olivier Cartiaux

Published in: European Spine Journal | Issue 11/2017

Abstract

Purpose

The goals of this study were to assess the accuracy of pedicle screw insertion using an intraoperative cone beam computed tomography (CBCT) system, and to analyze the factors potentially influencing this accuracy.

Methods

Six hundred and ninety-five pedicle screws were inserted in 118 patients between October 2013 and March 2016. Screw insertion was performed using 2D-fluoroscopy or CBCT-based navigation. Accuracy was assessed in terms of breach and reposition. All the intraoperative CBCT scans, done after screw insertion, were reviewed to assess the accuracy of screw placement using two established classification systems: Gertzbein and Heary. Generalized linear mixed models were used to model the odds (95% CI) for a screw to lead to a breach according to the independent variables.

Results

The breach rate was 11.7% using the Gertzbein classification and 15.4% using the Heary classification. Seventeen screws (2.4%) were repositioned intraoperatively. The only factor affecting statistically the odds to have a breach was the indication of surgery. The patients with non-degenerative disease had a significantly higher risk of breach than those with degenerative disease.

Conclusion

Use of intraoperative CBCT as 2D-fluoroscopy or coupled with a navigation system for pedicle screw insertion is accurate in terms of breach occurrence and reposition. However, these rates depend on the classification or grading system used. Use of a navigation system does not decrease the risk of breach significantly. And the risk of breach is higher in non-degenerative conditions (trauma, scoliosis, infection, and malignancy disease) than in degenerative diseases.

Boucher HH (1959) A method of spinal fusion. J Bone Jt Surg 41B(2):248–259

Boos N, Webb JK (1997) Pedicle screw fixation in spinal disorders: a European view. Eur Spine J 6(1):2–18CrossRefPubMedPubMedCentral

Donohue ML, Moquin RR, Singla A, Calancie B (2014) Is in vivo manual palpation for the thoracic pedicle screw instrumentation reliable? J Neurosurg Spine 20:492–496CrossRefPubMed

Jutte PC, Castelein RM (2002) Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J 11(6):594–598CrossRefPubMed

Li G, Lv G, Passias P et al (2010) Complications associated with thoracic pedicle screws in spinal deformity. Eur Spine J 19(9):1576–1584CrossRefPubMedPubMedCentral

Tian NF, Huang QS, Zhou P et al (2011) Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur Spine J 20(6):846–859CrossRefPubMed

Lonjon N, Chan-Seng E, Costalat V, Bonnafoux B, Vassal M, Boetto J (2015) Robot-assisted spine surgery: feasibility study through a prospective case-matched analysis. Eur Spine J. doi:10.1007/s00586-015-3758-8

Lamartina C, Cecchinato R, Fekete Z, Lipari A, Fiechter M, Berjano P (2015) Pedicle screw placement accuracy in thoracic and lumbar spinal surgery with a patient-matched targeting guide: a cadaveric study. Eur Spine J 24(Suppl 7):S937–S941CrossRef

Richter PH, Yarboro S, Kraus M, Gebhard F (2015) One year orthopaedic trauma experience using an advanced interdisciplinary hybrid operating room. Injury 46(Suppl 4):S129–S134CrossRefPubMed

10.

Raftopoulos C, Waterkeyn F, Fomekong E, Duprez T (2012) Percutaneous pedicle screw implantation for refractory low back pain: from manual 2D to fully robotic intraoperative 2D/3D fluoroscopy. Adv Tech Stand Neurosurg 38:75–93CrossRefPubMed

11.

Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976) 15(1):11–14CrossRef

12.

Heary RF, Bono CM, Black M (2004) Thoracic pedicle screws: postoperative computerized tomography scanning assessment. J Neurosurg 100(4 Suppl Spine):325–331PubMed

13.

Amato V, Giannachi L, Irace C, Corona C (2010) Accuracy of pedicle screw placement in the lumbosacral spine using conventional technique: computed tomography postoperative assessment in 102 consecutive patients. J Neurosurg Spine 12(3):306–313CrossRefPubMed

14.

Motiei-Langroudi R, Sadeghian H (2015) Assessment of pedicle screw placement accuracy in thoracolumbosacral spine using freehand technique aided by lateral fluoroscopy: results of postoperative computed tomography in 114 patients. Spine J 15(4):700–704CrossRefPubMed

15.

Kotani Y, Abumi K, Ito M, Takahata M, Sudo H, Ohshima S, Minami A (2007) Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique. Spine (Phila Pa 1976) 32(14):1543–1550CrossRef

16.

Ling JM, Dinesh SK, Pang BC et al (2013) Routine spinal navigation for thoracolumbar pedicle screw insertion using the O-arm three-dimensional imaging system improves placement accuracy. J Clin Neurosci 21(3):493–498CrossRefPubMed

17.

Scheufler KM, Franke J, Eckardt A, Dohmen H (2011) Accuracy of image-guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing. Part II: thoracolumbar spine. Neurosurgery 69(6):1307–1316CrossRefPubMed

18.

Kantelhardt SR, Martinez R, Baerwinkel S, Burger R, Giese A, Rohde V (2011) Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J 20(6):860–868CrossRefPubMedPubMedCentral

19.

Puvanesarajah V, Liauw J, Lo S, Lina I, Witham T (2014) Technique and accuracy of thoracolumbar pedicle screw placement. World J Orthop 5(2):112–123CrossRefPubMedPubMedCentral

20.

Parker S, McGirt M, Farber S et al (2011) Accuracy of free-hand pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws. Neurosurgery 68(1):170–178CrossRefPubMed

21.

Santos ER, Ledonio CG, Castro CA, Truong WH, Sembrano JN (2012) The accuracy of intraoperative O-arm images for the assessment of pedicle screw position. Spine (Phila Pa 1976) 37(2):E119–E125CrossRef

22.

Belmont PJ Jr, Klemme WR, Dhawan A, Polly DW Jr (2011) In vivo accuracy of thoracic pedicle screws. Spine (Phila Pa 1976) 26(21):2340–2346CrossRef

23.

Kosmopoulos V, Schizas C (2007) Pedicle screw placement accuracy: a meta-analysis. Spine 32(3):E111–E120CrossRefPubMed

24.

Gelalis ID, Paschos NK, Pakos EE, Politis AN et al (2012) Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J 21:247–255CrossRefPubMed

25.

Kaminski L, Cordemans V, Cartiaux O, Van Cauter M (2017) Radiation exposure to the patients in thoracic and lumbar spine fusion using a new intraoperative cone-beam computed tomography imaging technique: a preliminary study. Eur Spine J. doi:10.1007/s00586-017-4968-z

26.

Cordemans V, Kaminski L, Banse X, Cartiaux O (2017) Accuracy of a new intraoperative cone beam CT imaging technique (Artis zeego II) compared to postoperative CT scan for assessment of pedicle screws placement and breaches detection. Eur Spine J. doi:10.1007/s00586-017-5139-y

27.

Sclafani J, Regev G, Webb J, Garfin S, Kim C (2011) Use of quantitative pedicle screw accuracy system to assess new technology: initial studies on O-arm navigation and its effect on the learning curve of percutaneous pedicle screw insertion. SAS J 5:57–62. doi:10.1016/j.esas.2011.04.001 CrossRefPubMedPubMedCentral

28.

Kleck C, Cullilmore I, La Fleur M, Lindley E, Rentschler M, Burger E, Cain C, Patel V (2016) A new 3-dimensional method for measuring precision in surgical navigation and methods to optimize navigation accuracy. Eur Spine J 25(6):1764–1774. doi:10.1007/s00586-015-4235-0 CrossRefPubMed

29.

van Dijk JD, van den Ende RP, Stramigioli S, Köchling M, Höss N (2015) Clinical pedicle screw accuracy and deviation from planning in robot-guided spine surgery. Spine 40(17):E986–E991CrossRefPubMed

Title: Pedicle screw insertion accuracy in terms of breach and reposition using a new intraoperative cone beam computed tomography imaging technique and evaluation of the factors associated with these parameters of accuracy: a series of 695 screws
Authors: Virginie Cordemans
Ludovic Kaminski
Xavier Banse
Bernard G. Francq
Christine Detrembleur
Olivier Cartiaux
Publication date: 01-11-2017
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 11/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5195-3

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Pedicle screw insertion accuracy in terms of breach and reposition using a new intraoperative cone beam computed tomography imaging technique and evaluation of the factors associated with these parameters of accuracy: a series of 695 screws

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2017

Rate and mode of screw misplacements after 3D-fluoroscopy navigation-assisted insertion and 3D-imaging control of 1547 pedicle screws in spinal levels T10-S1 related to vertebrae and spinal sections

Effect of zoledronic acid on lumbar spinal fusion in osteoporotic patients

Accuracy of cannulated pedicle screw versus conventional pedicle screw for extra-pedicular screw placement in dysplastic pedicles without cancellous channel in adolescent idiopathic scoliosis: a computerized tomography (CT) analysis

Pull-out strength of patient-specific template-guided vs. free-hand fluoroscopically controlled thoracolumbar pedicle screws: a biomechanical analysis of a randomized cadaveric study

The current state of the evidence for the use of drains in spinal surgery: systematic review

Preoperative evaluation of left common iliac vein in oblique lateral interbody fusion at L5–S1