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. 2021 Aug;15(4):491-497.
doi: 10.31616/asj.2020.0068. Epub 2020 Sep 22.

Accuracy of Thoracolumbar Pedicle Screw Insertion Based on Routine Use of Intraoperative Imaging and Navigation

Pirateb Paramasivam Meenakshi Sundaram  1 , Jacob Yoong-Leong Oh  2 , Mark Tan  2 , Colum Patrick Nolan  3 , Chun Sing Yu  2 , Ji Min Ling  3
Affiliations

Accuracy of Thoracolumbar Pedicle Screw Insertion Based on Routine Use of Intraoperative Imaging and Navigation

Pirateb Paramasivam Meenakshi Sundaram et al. Asian Spine J. 2021 Aug.

Abstract

Study design: Retrospective review.

Purpose: To determine the accuracy of thoracolumbar pedicle screw insertion with the routine use of three-dimensional (3D) intraoperative imaging and navigation over a large series of screws in an Asian population.

Overview of literature: The use of 3D intraoperative imaging and navigation in spinal surgery is aimed at improving the accuracy of pedicle screw insertion. This study analyzed 2,240 pedicle screws inserted with the routine use of intraoperative navigation. It is one of very few studies done on an Asian population with a large series of screws.

Methods: Patients who had undergone thoracolumbar pedicle screws insertion using intraoperative imaging and navigation between 2009 and 2017 were retrospectively analyzed. Computed tomography (CT) images acquired after the insertion of pedicle screws were analyzed for breach of the pedicle wall. The pedicle screw breaches were graded according to the Gertzbein classification. The breach rate and revision rate were subsequently calculated.

Results: A total of 2,240 thoracolumbar pedicle screws inserted under the guidance of intraoperative navigation were analyzed, and the accuracy of the insertion was 97.41%. The overall breach rate was 2.59%, the major breach rate was 0.94%, and the intraoperative screw revision rate was 0.7%. There was no incidence of return to the operating theater for revision of screws.

Conclusions: The routine use of 3D navigation and intraoperative CT imaging resulted in consistently accurate pedicle screw placement. This improved the safety of spinal instrumentation and helped in avoiding revision surgery for malpositioned screws.

Keywords: Intraoperative imaging; Lumbar vertebrae; Navigation; Surgery; Thoracic vertebrae.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Number of screws inserted at each spinal level.
Fig. 2.
Fig. 2.
Incidence of pedicle screw breach at each spinal level.
Fig. 3.
Fig. 3.
(A) Grade 1 lateral breach of right pedicle screw. (B) Grade 2 lateral breach of right pedicle screw and grade 2 medial breach of left pedicle screw—pre-revision. (C) Breaches shown in Fig. 3B post-revision.
See this image and copyright information in PMC

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