Improved accuracy of pedicle screw insertion with computer-assisted surgery. A prospective clinical trial of 30 patients

Abstract

Study design: A prospective clinical trial was done to study the accuracy of pedicle screw placement in 30 consecutive computer-assisted orthopedic surgeries.

Objectives: To determine the accuracy and clinical applicability of this new method for pedicle screw insertion.

Summary of background data: Conventional screw insertion techniques have been associated with high pedicle screw malplacement rates in cadaver studies and clinical studies with postoperative computed tomography evaluation.

Methods: Thirty transpedicular, low-back, titanium instrumentations were performed with computer-assisted orthopedic surgery. The accuracy of screw placement was evaluated using a sophisticated computed tomography protocol.

Results: The total number of pedicle screws was 174. Of these, 139 (79.9%) could be inserted with computer-assisted orthopedic surgery. The malplacement rate of computer-assisted orthopedic surgery screws was 4.3%. In screws that were not inserted by computer-assisted orthopedic surgery, the malplacement rate was 14.3%. One malplaced screw that had not been inserted with computer-assisted orthopedic surgery caused L4 root paresis.

Conclusions: The accuracy of pedicle screw placement using computer-assisted surgery proved to be superior to the accuracy obtained when using conventional techniques.