Document Detail

Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: a retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement.
MedLine Citation:
PMID:  21039152     Owner:  NLM     Status:  MEDLINE    
OBJECT: The authors performed a retrospective clinical study to evaluate the feasibility and accuracy of cervical pedicle screw (CPS) placement using 3D fluoroscopy-based navigation (3D FN).
METHODS: The study involved 62 consecutive patients undergoing posterior stabilization of the cervical spine between 2003 and 2008. Thirty patients (126 screws) were treated using conventional techniques (CVTs) with a lateral fluoroscopic view, whereas 32 patients (150 screws) were treated using 3D FN. Screw positions were classified into 4 grades based on the pedicle wall perforations observed on postoperative CT.
RESULTS: The prevalence of perforations in the CVT group was 27% (34 screws): 92 (73.0%), 12 (9.5%), 6 (4.8%), and 16 (12.7%) for Grade 0 (no perforation), Grade 1 (perforation < 1 mm), Grade 2 (perforation ≥ 1 and < 2 mm), and Grade 3 (perforation ≥ 2 mm), respectively. In the 3D FN group, the prevalence of perforations was 18.7% (28 screws): 122 (81.3%), 17 (11.3%), 6 (4%), and 5 (3.3%) for Grades 0, 1, 2, and 3, respectively. Statistical analysis showed no significant difference in the prevalence of Grade 1 or higher perforations between the CVT and 3D FN groups. A higher prevalence of malpositioned CPSs was seen in Grade 2 or higher (17.5% vs 7.3%, p < 0.05) in the 3D FN group and Grade 3 (12.7% vs 7.3%, p < 0.05) perforations in the CVT group. The ORs for CPS malpositioning in the CVT group were 2.72 (95% CI 1.16-6.39) in Grade 2 or higher perforations and 3.89 (95% CI 1.26-12.02) in Grade 3 perforations.
CONCLUSIONS: Three-dimensional fluoroscopy-based navigation can improve the accuracy of CPS insertion; however, severe CPS malpositioning that causes injury to the vertebral artery or neurological complications can occur even with 3D FN. Advanced techniques for the insertion of CPSs and the use of modified insertion devices can reduce the risk of a malpositioned CPS and provide increased safety.
Yoshimoto Ishikawa; Tokumi Kanemura; Go Yoshida; Zenya Ito; Akio Muramoto; Shuichiro Ohno
Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Spine     Volume:  13     ISSN:  1547-5646     ISO Abbreviation:  J Neurosurg Spine     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-02     Completed Date:  2010-11-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101223545     Medline TA:  J Neurosurg Spine     Country:  United States    
Other Details:
Languages:  eng     Pagination:  606-11     Citation Subset:  IM    
Department of Spine and Orthopaedic Surgery, Konan Kosei Hospital, Konan City, Japan.
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MeSH Terms
Aged, 80 and over
Bone Screws*
Cervical Vertebrae / radiography,  surgery*
Feasibility Studies
Imaging, Three-Dimensional*
Middle Aged
Orthopedic Procedures / standards*
Postoperative Period
Retrospective Studies
Surgery, Computer-Assisted / methods*,  standards*
Tomography, X-Ray Computed
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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