Clinical accuracy of 3D fluoroscopy–assisted cervical pedicle screw insertion

Clinical article

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Object

Cervical pedicle screw (PS) misplacement leads to injury of the spinal cord, nerve root, and vertebral artery. Recently, several investigators reported on the usefulness of a spinal navigation system that improves the accuracy of PS insertion. In this study, the authors assessed the accuracy of cervical pedicle, lateral mass, and odontoid screw insertions placed using a 3D fluoroscopy navigation system, the Iso-C3D unit.

Methods

In this prospective analysis of the authors' initial 50 cases of 3D fluoroscopy–assisted cervical screw insertion, the authors inserted 176 PSs, 58 lateral mass screws, and 5 odontoid screws into the C1–7 vertebrae. They placed screws using intraoperative acquisition of data by the isocentric C-arm fluoroscope and a computer navigation system. They obtained postoperative fine-cut CT scans in all patients and assessed the accuracy of screw insertion.

Results

A PS (≥ 3.5 mm) could be inserted into 24 (63%) of 38 pedicles at the level of C-3, 18 (53%) of 34 pedicles at C-4, 30 (65%) of 46 at C-5, 33 (80%) of 41 at C-6, and 43 (100%) of 43 at C-7. Of 176 PSs inserted into vertebrae between C-2 and C-7, 171 screws (97.2%) were classified as Grade 1 (no pedicle perforation), and 5 screws (2.8%) were classified as Grade 2 (screw perforation of the cortex by up to 2 mm). Clinically significant screw deviation in the present study was considered Grade 3 (screw perforation of the cortex by > 2 mm), and this occurred in 0% of the placements.

Conclusions

In this study, the authors were able to correctly insert cervical PSs using the 3D fluoroscopy and navigation system.

Abbreviations used in this paper:LMS = lateral mass screw; PS = pedicle screw.

Article Information

Address correspondence to: Yasuo Ito, M.D., 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe City, Japan. email: y-ito@kobe.jrc.or.jp.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    The point of LMS and PS insertion was limited by screw–screw connection. That is, after placing an LMS in 1 vertebra, it was sometimes difficult to place a PS in the adjacent pedicle because the insertion points of the 2 screws were too near each other and caused connection difficulty. Black circle indicates insertion point of the LMS and the white circle, the insertion point of the PS.

  • View in gallery

    Graph showing the number of screws (y axis) inserted into the C1–7 vertebrae (x axis).

  • View in gallery

    A–C: Computed tomography 3D fluoroscopy can be used to generate an intraoperative, postprocedural image to verify the accuracy of screw placement.

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