Placement of pedicle screws using three-dimensional fluoroscopy-based navigation in lumbar vertebrae with axial rotation.
Despite potential advantages of three-dimensional fluoroscopy-based navigation, there still remain a lot of controversies about the indications of this technology, especially whether it is worthy of being used in placement of pedicle screws in lumbar spine. However, according to the inconsistent conclusions reported in the literature and our experiences, the traditional method relying on anatomical landmarks and fluoroscopic views to guide lumbar pedicle screw insertion is unable to meet the requirement of precise screw placement. Based on our observation, screw malposition seems to occur concomitant with vertebral axial rotation which is a ubiquitous phenomenon. Three-dimensional fluoroscopy-based navigation can provide the most valuable axial images in real-time, so it may be useful for placement of pedicle screws in lumbar spine. This study was intended to evaluate the effect of axial rotation of lumbar vertebrae on the accuracy of pedicle screw placement using the traditional method, as well as assess the value of three-dimensional fluoroscopy-based navigation in improving the accuracy. Sixteen lumbar simulation models at different degrees of axial rotation (0°, 5°, 10°, and 20°), with every four assigned the same degree, were equally divided into two groups (traditional method group and three-dimensional fluoroscopy-based navigation group). Random placement of pedicle screws was carried out, followed by CT scan postoperatively. Then the outer pedicle cortex contours were depicted from reconstructed sectional pedicle images using Photoshop. The accuracy of pedicle screw placement was evaluated by determining the interrelationship between screw trajectory and pedicle cortex (quality), and measuring the shortest distance from pedicle screw axis to outer cortex of the pedicle (quantity). Eighty pedicle screws were implanted, respectively, in each group. In traditional method group, statistical difference existed in the accuracy of pedicle screw placement at different axial rotational degrees (P < 0.05). With degrees increasing, the accuracy declined. The accuracy of three-dimensional fluoroscopy-based navigation group was higher than traditional method group in vertebrae with axial rotation (P < 0.01). In qualitative evaluation, the accuracy of the two methods had statistical difference when the degree was 20°, and in quantitative evaluation, statistical difference existed in 5°, 10°, and 20° of vertebral axial rotation.
Tian
Wei
W
Department of Spine Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, China. tianweijst@vip.163.com
Lang
Zhao
Z
D001696:Biomechanical Phenomena; D001863:Bone Screws; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008953:Models, Anatomic; D012399:Rotation
Acta Neurochir (Wien). 2003 Nov;145(11):949-54; discussion 954-5
14628199
J Bone Joint Surg Am. 1999 Nov;81(11):1519-28
10565643
J Bone Joint Surg Am. 1995 Aug;77(8):1193-9
7642664
Spine (Phila Pa 1976). 2000 Sep 15;25(18):2285-93
10984779
J Spinal Disord Tech. 2008 Feb;21(1):63-7
18418139
Spine (Phila Pa 1976). 2006 Jun 1;31(13):1467-72
16741456
Spine (Phila Pa 1976). 2001 Sep 15;26(18):2049-57
11547207
Spine (Phila Pa 1976). 1995 May 15;20(10):1208-12
7638668
Chirurgie. 1979;105(7):597-603
520095
J Bone Joint Surg Am. 2000 Oct;82(10):1458-76
11057475
J Bone Joint Surg Am. 1995 Aug;77(8):1200-6
7642665
J Spinal Disord Tech. 2005 Aug;18(4):369-75
16021020
Neurosurgery. 2004 May;54(5):1131-6; discussion 1136-7
15113467
Spine (Phila Pa 1976). 1996 Jun 1;21(11):1320-4
8725923
J Spinal Disord Tech. 2005 Jun;18(3):243-6
15905768
Eur Spine J. 1998;7(3):206-11
9684953
Spine (Phila Pa 1976). 1988 Sep;13(9):1012-8
3206294
Z Orthop Ihre Grenzgeb. 1992 Nov-Dec;130(6):479-83
1492451
Int Orthop. 1994;18(6):341-6
7698863
Spine (Phila Pa 1976). 2004 Dec 15;29(24):2856-60
15599290
Spine (Phila Pa 1976). 2001 Nov 1;26(21):2340-6
11679819
Spine (Phila Pa 1976). 2007 Feb 1;32(3):E111-20
17268254
Spine (Phila Pa 1976). 2007 Jan 15;32(2):E56-64
17224800
Clin Orthop Relat Res. 1986 Feb;(203):7-17
3955999