| Spinal Navigation: standard pre-operative versus intra-operative Computed Tomography data set acquisition for computer-guidance system. Radiological and clinical study in 100 consecutive patients. | |
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MedLine Citation:
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PMID: 21304425 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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ABSTRACT: Study Design. A retrospective clinical and radiological study.Objective. To compare the safety and accuracy of pedicle screw insertion using two different Computed Tomography (CT) data set acquisitions (pre-operative and intra-operative) for computer-guidance systems in a series of 100 consecutive patients.Summary of Background Data. Misplacement and pedicle cortical violation occurs in over 20% of screw placements and can result in potential neurovascular complications. Many technological innovations have been described to help reduce this range of error, such as image-guided surgery using fluoroscopy or CT-based image guidance. However, these techniques are not without their drawbacks. The next technological evolution is the use of an intra-operative CT scan, which would allow us to solve some of the critical phases of spinal navigation, such as position-dependent changes, thus granting a higher accuracy of the navigation system. The Authors have compared and discussed the results of a pre-operative and intra-operative CT data set acquisition mode for spinal navigation.Methods. 100 consecutive patients with a diagnosis of lumbar degenerative spondylolisthesis who underwent a surgical approach of lumbar pedicle screw fixation using a CT-based computer-guidance system were evaluated. The population was divided into two groups: in Group I a pre-operative CT scan was used for the navigation system while in Group II an intra-operative CT scan acquired during surgery was used. Epidemiological and surgical data of the patients in the two groups were then analyzed and compared. The Pearson chi-squared test was used for comparisons between groups (significance level 0.05). The evaluation and classification of the screw positioning was performed on the basis of a control CT scan according to the classification proposed by Laine.Results. Out of the 504 screws 471 were correctly inserted into the pedicles (93.5%): the accuracy of group I was of 91.8% while in group II it was 95.2% (no statistical significance). The overall rate of perforation was 6.5% (33 screws): 21 in group I and 12 in group II. 28 screws had a perforation of the pedicle < than 2 mm (grade I), 3 comprised from 2 to 4 (grade II), and only 2 more than 4 mm and less than 6 mm (grade III). Out of the 33 misplaced screws only one was replaced (graded as III in group II). Surgical time was shorter for group II, with a statistically significant difference. This result is mainly due to the automatic recognition and merging of the intra-operative images with the surgical anatomy that avoided the phase of registration with a paired-point technique.Conclusion. The results of this study suggest that the CT-based computer-assisted surgical navigation systems are precise, granting an elevated accuracy in pedicle screw positioning. |
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Authors:
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Costa Francesco; Cardia Andrea; Alessandro Ortolina; Galbusera Fabio; Zerbi Alberto; Fornari Maurizio |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-2-7 |
Journal Detail:
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Title: Spine Volume: - ISSN: 1528-1159 ISO Abbreviation: - Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-2-9 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7610646 Medline TA: Spine (Phila Pa 1976) Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1 Neurosurgery Department - IRCCS Istituto O. Galeazzi, Milan; 2 LaBs - IRCCS Istituto O. Galeazzi, Milan. 3 Radiology - IRCCS Istituto O. Galeazzi, Milan. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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