The accuracy of pedicle screw placement using intraoperative image guidance systems

A systematic review

View More View Less
  • 1 Justin Parker Neurological Institute, and
  • | 2 Boulder Neurosurgical Associates, Boulder, Colorado
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

Several retrospective studies have demonstrated higher accuracy rates and increased safety for navigated pedicle screw placement than for free-hand techniques; however, the accuracy differences between navigation systems has not been extensively studied. In some instances, 3D fluoroscopic navigation methods have been reported to not be more accurate than 2D navigation methods for pedicle screw placement. The authors of this study endeavored to identify if 3D fluoroscopic navigation methods resulted in a higher placement accuracy of pedicle screws.

Methods

A systematic analysis was conducted to examine pedicle screw insertion accuracy based on the use of 2D, 3D, and conventional fluoroscopic image guidance systems. A PubMed and MEDLINE database search was conducted to review the published literature that focused on the accuracy of pedicle screw placement using intraoperative, real-time fluoroscopic image guidance in spine fusion surgeries. The pedicle screw accuracy rates were segregated according to spinal level because each spinal region has individual anatomical and morphological variations. Descriptive statistics were used to compare the pedicle screw insertion accuracy rate differences among the navigation methods.

Results

A total of 30 studies were included in the analysis. The data were abstracted and analyzed for the following groups: 12 data sets that used conventional fluoroscopy, 8 data sets that used 2D fluoroscopic navigation, and 20 data sets that used 3D fluoroscopic navigation. These studies included 1973 patients in whom 9310 pedicle screws were inserted. With conventional fluoroscopy, 2532 of 3719 screws were inserted accurately (68.1% accuracy); with 2D fluoroscopic navigation, 1031 of 1223 screws were inserted accurately (84.3% accuracy); and with 3D fluoroscopic navigation, 4170 of 4368 screws were inserted accurately (95.5% accuracy). The accuracy rates when 3D was compared with 2D fluoroscopic navigation were also consistently higher throughout all individual spinal levels.

Conclusions

Three-dimensional fluoroscopic image guidance systems demonstrated a significantly higher pedicle screw placement accuracy than conventional fluoroscopy or 2D fluoroscopic image guidance methods.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Açikbaş SC, , Arslan FY, & Tuncer MR: The effect of transpedicular screw misplacement on late spinal stability. Acta Neurochir (Wien) 145:949955, 2003

    • Search Google Scholar
    • Export Citation
  • 2

    Belmont PJ Jr, , Klemme WR, , Dhawan A, & Polly DW Jr: In vivo accuracy of thoracic pedicle screws. Spine (Phila Pa 1976) 26:23402346, 2001

    • Search Google Scholar
    • Export Citation
  • 3

    Benson K, & Hartz AJ: A comparison of observational studies and randomized, controlled trials. Am J Ophthalmol 130:688, 2000

  • 4

    Castro WH, , Halm H, , Jerosch J, , Malms J, , Steinbeck J, & Blasius S: Accuracy of pedicle screw placement in lumbar vertebrae. Spine (Phila Pa 1976) 21:13201324, 1996

    • Search Google Scholar
    • Export Citation
  • 5

    Egger M, , Schneider M, & Davey Smith G: Spurious precision? Meta-analysis of observational studies. BMJ 316:140144, 1998

  • 6

    Esses SI, , Sachs BL, & Dreyzin V: Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members. Spine (Phila Pa 1976) 18:22312239, 1993

    • Search Google Scholar
    • Export Citation
  • 7

    Foley KT, , Holly LT, & Schwender JD: Minimally invasive lumbar fusion. Spine (Phila Pa 1976) 28:15 Suppl S26S35, 2003

  • 8

    Fraser J, , Gebhard H, , Irie D, , Parikh K, & Härtl R: Iso-C/3-dimensional neuronavigation versus conventional fluoroscopy for minimally invasive pedicle screw placement in lumbar fusion. Minim Invasive Neurosurg 53:184190, 2010

    • Search Google Scholar
    • Export Citation
  • 9

    Fu TS, , Chen LH, , Wong CB, , Lai PL, , Tsai TT, & Niu CC, et al.: Computer-assisted fluoroscopic navigation of pedicle screw insertion: an in vivo feasibility study. Acta Orthop Scand 75:730735, 2004

    • Search Google Scholar
    • Export Citation
  • 10

    Fu TS, , Wong CB, , Tsai TT, , Liang YC, , Chen LH, & Chen WJ: Pedicle screw insertion: computed tomography versus fluoroscopic image guidance. Int Orthop 32:517521, 2008

    • Search Google Scholar
    • Export Citation
  • 11

    Gautschi OP, , Schatlo B, , Schaller K, & Tessitore E: Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws. Neurosurg Focus 31:4 E8, 2011

    • Search Google Scholar
    • Export Citation
  • 12

    Guzey FK, , Emel E, , Hakan Seyithanoglu M, , Serdar Bas N, , Ozkan N, & Sel B, et al.: Accuracy of pedicle screw placement for upper and middle thoracic pathologies without coronal plane spinal deformity using conventional methods. J Spinal Disord Tech 19:436441, 2006

    • Search Google Scholar
    • Export Citation
  • 13

    Hicks JM, , Singla A, , Shen FH, & Arlet V: Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976) 35:E465E470, 2010

    • Search Google Scholar
    • Export Citation
  • 14

    Hodges SD, , Eck JC, & Newton D: Analysis of CT-based navigation system for pedicle screw placement. Orthopedics 35:e1221e1224, 2012

  • 15

    Hott JS, , Deshmukh VR, , Klopfenstein JD, , Sonntag VK, , Dickman CA, & Spetzler RF, et al.: Intraoperative Iso-C C-arm navigation in craniospinal surgery: the first 60 cases. Neurosurgery 54:11311137, 2004

    • Search Google Scholar
    • Export Citation
  • 16

    Houten JK, , Nasser R, & Baxi N: Clinical assessment of percutaneous lumbar pedicle screw placement using the O-arm multidimensional surgical imaging system. Neurosurgery 70:990995, 2012

    • Search Google Scholar
    • Export Citation
  • 17

    Hubbe U, , Kogias E, & Vougioukas VI: Image guided percutaneous trans-pedicular screw fixation of the thoracic spine. A clinical evaluation. Acta Neurochir (Wien) 151:545549, 2009

    • Search Google Scholar
    • Export Citation
  • 18

    Ishikawa Y, , Kanemura T, , Yoshida G, , Ito Z, , Muramoto A, & Ohno S: Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: a retrospective comparative study of conventional versus computerassisted cervical pedicle screw placement. Clinical article. J Neurosurg Spine 13:606611, 2010

    • Search Google Scholar
    • Export Citation
  • 19

    Ishikawa Y, , Kanemura T, , Yoshida G, , Matsumoto A, , Ito Z, & Tauchi R, et al.: Intraoperative, full-rotation, three-dimensional image (O-arm)-based navigation system for cervical pedicle screw insertion. Clinical article. J Neurosurg Spine 15:472478, 2011

    • Search Google Scholar
    • Export Citation
  • 20

    Ito Y, , Sugimoto Y, , Tomioka M, , Hasegawa Y, , Nakago K, & Yagata Y: Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion. Clinical article. J Neurosurg Spine 9:450453, 2008

    • Search Google Scholar
    • Export Citation
  • 21

    Kakarla UK, , Little AS, , Chang SW, , Sonntag VK, & Theodore N: Placement of percutaneous thoracic pedicle screws using neuronavigation. World Neurosurg 74:606610, 2010

    • Search Google Scholar
    • Export Citation
  • 22

    Kim CW, , Lee YP, , Taylor W, , Oygar A, & Kim WK: Use of navigation-assisted fluoroscopy to decrease radiation exposure during minimally invasive spine surgery. Spine J 8:584590, 2008

    • Search Google Scholar
    • Export Citation
  • 23

    Kosmopoulos V, & Schizas C: Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976) 32:E111E120, 2007

  • 24

    Laine T, , Schlenzka D, , Mäkitalo K, , Tallroth K, , Nolte LP, & Visarius H: Improved accuracy of pedicle screw insertion with computer-assisted surgery. A prospective clinical trial of 30 patients. Spine (Phila Pa 1976) 22:12541258, 1997

    • Search Google Scholar
    • Export Citation
  • 25

    Learch TJ, , Massie JB, , Pathria MN, , Ahlgren BA, & Garfin SR: Assessment of pedicle screw placement utilizing conventional radiography and computed tomography: a proposed systematic approach to improve accuracy of interpretation. Spine (Phila Pa 1976) 29:767773, 2004

    • Search Google Scholar
    • Export Citation
  • 26

    Lee GY, , Massicotte EM, & Rampersaud YR: Clinical accuracy of cervicothoracic pedicle screw placement: a comparison of the “open” lamino-foraminotomy and computer-assisted techniques. J Spinal Disord Tech 20:2532, 2007

    • Search Google Scholar
    • Export Citation
  • 27

    Lekovic GP, , Potts EA, , Karahalios DG, & Hall G: A comparison of two techniques in image-guided thoracic pedicle screw placement: a retrospective study of 37 patients and 277 pedicle screws. J Neurosurg Spine 7:393398, 2007

    • Search Google Scholar
    • Export Citation
  • 28

    Liljenqvist UR, , Halm HF, & Link TM: Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976) 22:22392245, 1997

    • Search Google Scholar
    • Export Citation
  • 29

    Liu YJ, , Tian W, , Liu B, , Li Q, , Hu L, & Li ZY, et al.: Comparison of the clinical accuracy of cervical (C2-C7) pedicle screw insertion assisted by fluoroscopy, computed tomography-based navigation, and intraoperative three-dimensional C-arm navigation. Chin Med J (Engl) 123:29952998, 2010

    • Search Google Scholar
    • Export Citation
  • 30

    Manchikanti L, , Datta S, , Smith HS, & Hirsch JA: Evidence-based medicine, systematic reviews, and guidelines in interventional pain management: part 6. Systematic reviews and meta-analyses of observational studies. Pain Physician 12:819850, 2009

    • Search Google Scholar
    • Export Citation
  • 31

    Merloz P, , Troccaz J, , Vouaillat H, , Vasile C, , Tonetti J, & Eid A, et al.: Fluoroscopy-based navigation system in spine surgery. Proc Inst Mech Eng H 221:813820, 2007

    • Search Google Scholar
    • Export Citation
  • 32

    Mirza SK, , Wiggins GC, , Kuntz C IV, , York JE, , Bellabarba C, & Knonodi MA, et al.: Accuracy of thoracic vertebral body screw placement using standard fluoroscopy, fluoroscopic image guidance, and computed tomographic image guidance: a cadaver study. Spine (Phila Pa 1976) 28:402413, 2003

    • Search Google Scholar
    • Export Citation
  • 33

    Nakashima H, , Sato K, , Ando T, , Inoh H, & Nakamura H: Comparison of the percutaneous screw placement precision of isocentric C-arm 3-dimensional fluoroscopy-navigated pedicle screw implantation and conventional fluoroscopy method with minimally invasive surgery. J Spinal Disord Tech 22:468472, 2009

    • Search Google Scholar
    • Export Citation
  • 34

    Nottmeier EW, & Fenton D: Three-dimensional image-guided placement of percutaneous pedicle screws without the use of biplanar fluoroscopy or Kirschner wires: technical note. Int J Med Robot 6:483488, 2010

    • Search Google Scholar
    • Export Citation
  • 35

    Park P, , Foley KT, , Cowan JA, & Marca FL: Minimally invasive pedicle screw fixation utilizing O-arm fluoroscopy with computer-assisted navigation: feasibility, technique, and preliminary results. Surg Neurol Int 1:44, 2010

    • Search Google Scholar
    • Export Citation
  • 36

    Patil S, , Lindley EM, , Burger EL, , Yoshihara H, & Patel VV: Pedicle screw placement with O-arm and stealth navigation. Orthopedics 35:e61e65, 2012

    • Search Google Scholar
    • Export Citation
  • 37

    Rajan VV, , Kamath V, , Shetty AP, & Rajasekaran S: Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine. Indian J Orthop 44:163168, 2010

    • Search Google Scholar
    • Export Citation
  • 38

    Rajasekaran S, , Vidyadhara S, , Ramesh P, & Shetty AP: Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976) 32:E56E64, 2007

    • Search Google Scholar
    • Export Citation
  • 39

    Rampersaud YR, & Lee KS: Fluoroscopic computer-assisted pedicle screw placement through a mature fusion mass: an assessment of 24 consecutive cases with independent analysis of computed tomography and clinical data. Spine (Phila Pa 1976) 32:217222, 2007

    • Search Google Scholar
    • Export Citation
  • 40

    Rampersaud YR, , Pik JH, , Salonen D, & Farooq S: Clinical accuracy of fluoroscopic computer-assisted pedicle screw fixation: a CT analysis. Spine (Phila Pa 1976) 30:E183E190, 2005

    • Search Google Scholar
    • Export Citation
  • 41

    Ravi B, , Zahrai A, & Rampersaud R: Clinical accuracy of computer-assisted two-dimensional fluoroscopy for the percutaneous placement of lumbosacral pedicle screws. Spine (Phila Pa 1976) 36:8491, 2011

    • Search Google Scholar
    • Export Citation
  • 42

    Resnick DK: Prospective comparison of virtual fluoroscopy to fluoroscopy and plain radiographs for placement of lumbar pedicle screws. J Spinal Disord Tech 16:254260, 2003

    • Search Google Scholar
    • Export Citation
  • 43

    Sanborn MR, , Thawani JP, , Whitmore RG, , Shmulevich M, , Hardy B, & Benedetto C, et al.: Cost-effectiveness of confirmatory techniques for the placement of lumbar pedicle screws. Neurosurg Focus 33:1 E12, 2012

    • Search Google Scholar
    • Export Citation
  • 44

    Schizas C, , Michel J, , Kosmopoulos V, & Theumann N: Computer tomography assessment of pedicle screw insertion in percutaneous posterior transpedicular stabilization. Eur Spine J 16:613617, 2007

    • Search Google Scholar
    • Export Citation
  • 45

    Schwarzenbach O, , Berlemann U, , Jost B, , Visarius H, , Arm E, & Langlotz F, et al.: Accuracy of computer-assisted pedicle screw placement. An in vivo computed tomography analysis. Spine (Phila Pa 1976) 22:452458, 1997

    • Search Google Scholar
    • Export Citation
  • 46

    Shin MH, , Ryu KS, & Park CK: Accuracy and safety in pedicle screw placement in the thoracic and lumbar spines: comparison study between conventional C-arm fluoroscopy and navigation coupled with O-arm® guided methods. J Korean Neurosurg Soc 52:204209, 2012

    • Search Google Scholar
    • Export Citation
  • 47

    Shrier I, , Boivin JF, , Steele RJ, , Platt RW, , Furlan A, & Kakuma R, et al.: Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles. Am J Epidemiol 166:12031209, 2007

    • Search Google Scholar
    • Export Citation
  • 48

    Silbermann J, , Riese F, , Allam Y, , Reichert T, , Koeppert H, & Gutberlet M: Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between free-hand and O-arm based navigation techniques. Eur Spine J 20:875881, 2011

    • Search Google Scholar
    • Export Citation
  • 49

    Simunovic N, , Sprague S, & Bhandari M: Methodological issues in systematic reviews and meta-analyses of observational studies in orthopaedic research. J Bone Joint Surg Am 91:Suppl 3 8794, 2009

    • Search Google Scholar
    • Export Citation
  • 50

    Slomczykowski M, , Roberto M, , Schneeberger P, , Ozdoba C, & Vock P: Radiation dose for pedicle screw insertion. Fluoroscopic method versus computer-assisted surgery. Spine (Phila Pa 1976) 24:975983, 1999

    • Search Google Scholar
    • Export Citation
  • 51

    Sugimoto Y, , Ito Y, , Tomioka M, , Shimokawa T, , Shiozaki Y, & Mazaki T, et al.: Upper lumbar pedicle screw insertion using three-dimensional fluoroscopy navigation: assessment of clinical accuracy. Acta Med Okayama 64:293297, 2010

    • Search Google Scholar
    • Export Citation
  • 52

    Tian NF, , Huang QS, , Zhou P, , Zhou Y, , Wu RK, & Lou Y, et al.: Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur Spine J 20:846859, 2011

    • Search Google Scholar
    • Export Citation
  • 53

    Tormenti MJ, , Kostov DB, , Gardner PA, , Kanter AS, , Spiro RM, & Okonkwo DO: Intraoperative computed tomography image-guided navigation for posterior thoracolumbar spinal instrumentation in spinal deformity surgery. Neurosurg Focus 28:3 E11, 2010

    • Search Google Scholar
    • Export Citation
  • 54

    Upendra BN, , Meena D, , Chowdhury B, , Ahmad A, & Jayaswal A: Outcome-based classification for assessment of thoracic pedicular screw placement. Spine (Phila Pa 1976) 33:384390, 2008

    • Search Google Scholar
    • Export Citation
  • 55

    Van de Kelft E, , Costa F, , Van der Planken D, & Schils F: A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation. Spine (Phila Pa 1976) 37:E1580E1587, 2012

    • Search Google Scholar
    • Export Citation
  • 56

    Verma R, , Krishan S, , Haendlmayer K, & Mohsen A: Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws. Eur Spine J 19:370375, 2010

    • Search Google Scholar
    • Export Citation
  • 57

    Villavicencio AT, , Burneikiene S, , Bulsara KR, & Thramann JJ: Utility of computerized isocentric fluoroscopy for minimally invasive spinal surgical techniques. J Spinal Disord Tech 18:369375, 2005

    • Search Google Scholar
    • Export Citation
  • 58

    Vougioukas VI, , Weber J, & Scheufler KM: Clinical and radiological results after parapedicular screw fixation of the thoracic spine. J Neurosurg Spine 3:283287, 2005

    • Search Google Scholar
    • Export Citation
  • 59

    Waschke A, , Walter J, , Duenisch P, , Reichart R, , Kalff R, & Ewald C: CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4,500 screws. Eur Spine J 22:654660, 2013

    • Search Google Scholar
    • Export Citation
  • 60

    Watkins RG, , Gupta A, & Watkins RG: Cost-effectiveness of image-guided spine surgery. Open Orthop J 4:228233, 2010

  • 61

    Welch WC, , Subach BR, , Pollack IF, & Jacobs GB: Frameless stereotactic guidance for surgery of the upper cervical spine. Neurosurgery 40:958964, 1997

    • Search Google Scholar
    • Export Citation
  • 62

    Yang YL, , Zhou DS, & He JL: Comparison of isocentric C-arm 3-dimensional navigation and conventional fluoroscopy for C1 lateral mass and C2 pedicle screw placement for atlantoaxial instability. J Spinal Disord Tech 26:127134, 2013

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1382 814 56
Full Text Views 1140 107 13
PDF Downloads 770 119 9
EPUB Downloads 0 0 0