title: Navigated guide tube for the placement of mini-open pedicle screws using stereotactic 3D navigation without the use of K-wires: technical note.
abstract: OBJECTIVE
  Three-dimensional spinal navigation increases screw accuracy, but its implementation in clinical practice has been difficult, mainly because of surgeons' concerns about increased operative times, disturbance of workflow, and safety. The authors present a custom-designed navigated guide that addresses some of these concerns by allowing for drilling, tapping, and placing the final screw via a minimally invasive approach without the need for K-wires. In this paper, the authors' goal was to describe the technical aspects of the navigated guide tube as well as pedicle screw accuracy.
  
  
  METHODS
  The authors present the technical details of a navigated guide that allows drilling, tapping, and the placement of the final screw without the need for K-wires. The first 10 patients who received minimally invasive mini-open spinal pedicle screws are presented. The case series focuses on the immediate postoperative outcomes, pedicle screw accuracy, and pedicle screw-related complications. An independent board-certified neuroradiologist determined pedicle screw accuracy according to a 4-tiered grading system.
  
  
  RESULTS
  The navigated guide allowed successful placement of mini-open pedicle screws as part of posterior fixation from L-1 to S-1 without the use of K-wires. Only 7-mm-diameter screws were placed, and 72% of screws were completely contained within the pedicle. Breaches less than 2 mm were seen in 23% of cases, and these were all lateral except for one screw. Breaches were related to the lateral to medial trajectory chosen to avoid the superior facet joint. There were no complications related to pedicle screw insertion.
  
  
  CONCLUSIONS
  A novel customized navigated guide tube is presented that facilitates the workflow and allows accurate placement of mini-open pedicle screws without the need for K-wires.
authors.affiliation: Department of Radiology, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Shin
authors.forename: Innocent U
authors.initials: IU
authors.lastname: Njoku
authors.forename: A John
authors.initials: AJ
authors.lastname: Tsiouris
authors.forename: Roger
authors.initials: R
authors.lastname: Härtl
mesh_terms: D001863:Bone Screws; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013131:Spine / Q000601:surgery*