title: Segmental pedicle screwing for idiopathic scoliosis using computer-assisted surgery.
abstract: METHODS
  Retrospective clinical study.
  
  
  OBJECTIVE
  To evaluate the accuracy of computer-assisted surgery for idiopathic scoliosis.
  
  
  BACKGROUND
  Segmental pedicle screw fixation has been proven to enable enhanced correction of scoliotic deformities. However, both neurovascular and visceral structures are at potential risk from screw misplacement due to pedicle drift. No reports exist on the accuracy and benefits of computer-assisted surgery for pedicle screwing in scoliosis surgery.
  
  
  METHODS
  A total of 40 consecutive patients with idiopathic scoliosis were evaluated. Postoperative computed tomography was assessed for the accuracy of pedicle screw placement in 20 cases treated without a navigation system and 20 cases with a computed tomography-based navigation system. Correlations between registered levels and pedicle perforation were investigated.
  
  
  RESULTS
  Pedicle violation was observed in 28.0% of the control group and 11.4% of the navigation group, with significant differences. No screw misplacements at the registered levels were seen, and the longer the distance between the registered level and level of screw insertion, the higher the rate of pedicle violation. No intraoperative complications caused by pedicle perforation occurred.
  
  
  CONCLUSIONS
  In the navigation group, a tendency to lateral perforation at the concave side and medial perforation at the convex side was noted, like in the control group. Use of the navigation system significantly reduced the screw misplacement rate for rotated vertebrae as compared with the control group. Separate registration is recommended for rotated vertebrae when possible.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University School of Medicine, Nagoya, Japan. jsakai@med.nagoya-u.ac.jp
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Sakai
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakamura
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Katayama
authors.forename: Shiro
authors.initials: S
authors.lastname: Imagama
authors.forename: Zenya
authors.initials: Z
authors.lastname: Ito
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome