title: [Clinical accuracy of fluoroscopic navigation at the thoracic and lumbar spine].
abstract: The aim of the present study was the verification of the accuracy of 2D fluoroscopy-based navigated pedicle screw placements at the thoracic and lumbar spine in a case series of traumatised patients. Within 36 months 111 pedicle screws were instrumented using C-arm based navigation in 29 patients, 60 at the thoracic and 51 at the lumbar spine. All screw positions were evaluated postoperatively by a routine thin-slice CT scan using multiplanar reconstruction. The position of a screw in relation of its pedicle was classified as: a) screw completely intraosseous, b) screw perforated less than thread level and c) screw perforated over thread level. In 34 thoracic (56.7%) and 32 lumbar (62.7%) screws complete intraosseous placement was observed, 14 thoracic screws (23.3%) and 14 lumbar screws (27.5%) perforated less than thread level. Perforations over thread level were found in 12 thoracic (20%) and 5 lumbar (9.8%) screws. Only medial and lateral perforations of the pedicle were documented (without neurological signs), cranial or caudal perforations did not occur. Segmentation of the C-arm navigation into two comparable treatment periods showed a learning curve with a reduction of perforations in the second sequence (after 57 pedicle instrumentations) of about 15%, this was not found to be statistically significant. The fluoroscopic navigation of pedicle screws is a safe procedure at the lumbar spine with equal accuracy compared to the non-navigated conventional instrumentation. Application of C-arm navigation at the thoracic spine showed more inaccuracies, so that 3D-based navigation seems to be more advantageous in this region.
authors.affiliation: Klinik für Unfallchirurgie, Hand-, Plastische- und Wiederherstellungschirurgie des Universitätsklinikum Ulm, Ulm. Markus.Arand@kliniken-lb.de
authors.forename: M
authors.initials: M
authors.lastname: Arand
authors.forename: S
authors.initials: S
authors.lastname: Teller
authors.forename: F
authors.initials: F
authors.lastname: Gebhard
authors.forename: M
authors.initials: M
authors.lastname: Schultheiss
authors.forename: P
authors.initials: P
authors.lastname: Keppler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D013123:Spinal Fusion / Q000379:methods*; D025321:Surgery, Computer-Assisted; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D036542:Tomography, Spiral Computed