Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Feb 1;37(3):E188-94.
doi: 10.1097/BRS.0b013e31822a2e0a.

Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation

A Noelle Larson  1 , Edward R G Santos, David W Polly Jr, Charles G T Ledonio, Jonathan N Sembrano, Cary H Mielke, Kenneth J Guidera
Affiliations

Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation

A Noelle Larson et al. Spine (Phila Pa 1976). .

Abstract

Study design: A retrospective cohort study reporting the use of intraoperative computed tomography (CT) and image-guided navigation system for the placement of pedicle screws in pediatric compared with adult patients.

Objective: To evaluate the accuracy of open pedicle screw placement in pediatric patients using intraoperative CT and 3-dimensional (3D) image-guided navigation.

Summary of background data: Pedicle screws are widely used in children for the correction of spinal deformity. Navigation systems and intraoperative CT are now available as an adjunct to fluoroscopy and anatomic techniques for placing pedicle screws and verifying screw position.

Methods: From 2007 to 2010, 984 pedicle screws were placed in a consecutive series cohort of 50 pediatric patients for spinal deformity correction with the use of intraoperative CT (O-arm, Medtronic, Inc, Louisville, CO) and a computerized navigation system (Stealth, Medtronic, Inc, Louisville, CO). The primary outcome measure for this study is redirection or removal of screw on the basis of the intraoperative CT imaging. During the study period, 1511 screws were placed in adult patients using the same image guidance system.

Results: A total of 984 pedicle screws were implanted using real-time navigation, with a mean of 20 screws per patient (range: 2-34). On the basis of intraoperative CT, 35 screws (3.6%) were revised (27 redirected and 8 removed), representing a 96.4% accuracy rate. No patients returned to the operating room because of screw malposition.Of the 1511 screws placed in adult patients, 28 (1.8%) were revised intraoperatively for malposition on CT imaging, for an overall 98.2% accuracy rate. Screw revision thus was more common in the pediatric population (P = 0.008). However, the pediatric screw accuracy rate is significantly higher than the findings from a recent meta-analysis of predominantly nonnavigated screws in children, reporting a 94.9% accuracy rate (P = 0.03).

Conclusion: We report 96.4% accuracy in pediatric pedicle screw placement using intraoperative CT and a 3D navigation system. This is similar to other reports and has better accuracy than a recent meta-analysis of nonnavigated screws in children.

PubMed Disclaimer