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. 2024 Sep 3;16(9):e68558.
doi: 10.7759/cureus.68558. eCollection 2024 Sep.

Accuracy of Cervical Pedicle Screw Insertion With and Without a Navigation-Linked High-Speed Drill: A Retrospective Clinical Study

Kosei Ono  1 , Sohei Murata  1 , Mutsumi Matsushita  1 , Yu Shimizu  1 , Yusuke Nakamura  1 , Taisuke Yabe  1 , Hiromu Ito  1
Affiliations

Accuracy of Cervical Pedicle Screw Insertion With and Without a Navigation-Linked High-Speed Drill: A Retrospective Clinical Study

Kosei Ono et al. Cureus. .

Abstract

Introduction: Cervical pedicle screw (CPS) fixation provides high stability but poses a risk of nerve and vascular injury. Although useful for reducing CPS deviation rates, navigation systems cannot completely eliminate deviation. This study aimed to compare two methods for creating insertion paths, one using a navigation-linked high-speed drill (NAVI drill) and the other using conventional manual probing.

Methods: Our study comprised 104 patients with 509 CPSs at the C3-6 level who were treated at our institution between 2017 and 2023. CPS deviations were graded according to the Neo classification system, and the deviation direction (medial, lateral, cranial, or caudal) was assessed. Complications associated with CPS deviation were also investigated. We compared cases that used the NAVI drill (Group M) with those that used manual probing (Group N).

Results: Group M included 45 cases (252 screws), and Group N included 59 cases (257 screws). The CPS deviation rate was grade 1 or higher in 14.7% and 17.1% of cases in Groups M and N, respectively (p = 0.469). It was grade 2 or higher in 1.2% and 4.3% of cases in Groups M and N, respectively (p = 0.222). The medial, lateral, caudal, and cranial deviation direction rates were 56.8%, 2.7%, 40.5%, and 0% in Group M and 13.6%, 72.7%, 11.4%, and 2.3% in Group N, respectively (p < 0.001). In one case in Group N, a grade 3 lateral deviation resulted in vertebral artery injury (VAI).

Conclusions: The use of the NAVI drill was associated with a slightly lower, albeit insignificant, CPS deviation rate. However, it significantly lowered the proportion of lateral deviations. Therefore, the NAVI drill is a useful tool for preventing VAI.

Keywords: cervical pedicle screw; high-speed drill; navigation; neo classification; vertebral artery injury.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. The Medical Ethics Committee of Kurashiki Central Hospital issued approval 4407. This study was approved by our institutional review board. Owing to its retrospective nature, the need for informed consent was waived. The patients were provided with an opt-out option. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Imaging results (Group N, lateral, grade 3 deviation)
A: Computed tomography image of the dislodged screw. B: Magnetic resonance image of the cerebellar infarction. C and D: Post-embolization X-ray images.
See this image and copyright information in PMC

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