title: Placement of percutaneous thoracic pedicle screws using neuronavigation.
abstract: BACKGROUND
  Percutaneous thoracic pedicle screw fixation is challenging because of the complexity of the spinal anatomy and obscuration of normal surgical landmarks by soft tissue. We report a novel percutaneous technique in which intraoperative Iso-C C-arm navigation was used to treat complex thoracic spinal fractures.
  
  
  METHODS
  Between March and September 2007, percutaneous thoracic pedicle screw fixation was performed with the assistance of intraoperative Iso-C C-arm fluoroscopy in six patients (two males, four females; mean age=33 years, range=16-61 years) with unstable thoracic fractures. The accuracy of pedicle screw placement was assessed by postoperative computed tomography and graded according to the method of Youkilis et al.
  
  
  RESULTS
  Five patients had unstable acute traumatic fractures and one had an osteoporotic burst fracture. Altogether, 19 spinal segments (range=2-4/patient) were fixated using 37 pedicle screws. Pedicle screw misplacement was grade II in 16% and grade III in 3%. None of the patients had neurologic consequences due to screw misplacement, and none required conversion to an open procedure or revision of hardware. There was one wound infection.
  
  
  CONCLUSIONS
  Percutaneous thoracic pedicle screw fixation with intraoperative neuronavigation for the stabilization of complex spinal fractures is feasible and associated with acceptable rates of accuracy and morbidity.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Udaya K
authors.initials: UK
authors.lastname: Kakarla
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Little
authors.forename: Steve W
authors.initials: SW
authors.lastname: Chang
authors.forename: Volker K H
authors.initials: VK
authors.lastname: Sonntag
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult