title: Feasibility of Intra-operative Computed Tomography Navigation System for Pedicle Screw Insertion of the Thoraco-lumbar Spine.
abstract: STUDY DESIGN:: A retrospective analysis of feasibility of intraoperative computed tomography (iCT) navigation for pedicle screw insertion of the thoraco-lumbar spine OBJECTIVES:: This study assessed the feasibility of an iCT navigation system by evaluating the screw insertion time, screw revision time, and learning curve of the iCT surgical team in patients who underwent thoraco-lumbar pedicle screw surgery using this navigation system. SUMMARY OF BACKGROUND DATA:: The iCT navigation system has been reported to improve the accuracy and safety of pedicle screw insertion. However, the assessment of the feasibility of spinal instrumentation guided by iCT navigation system is limited. METHODS:: From the time iCT navigation system was set-up to a period covering 16 months, consecutive patients who underwent thoracic or lumbar spinal pedicle screw surgery were enrolled. The screw insertion and screw revision times were estimated using the system's automatic time recording between the intra-operative CT scans. The insertion time per screw of the first 50 patients not requiring screw revision was also analyzed to evaluate the learning curve of the iCT surgical team. RESULTS:: There were 178 patients with a total of 932 pedicle screws. The cortical breach rate was 3.2% and the screw revision rate was 1.4%. The insertion time per screw was 10.2±6.3▒min and the screw revision time was 13.8±9.9▒min. The learning curve of the iCT surgical team for pedicle screw insertion guided by this navigation system was not steep and experience from less than 10 patients was adequate to provide familiarity with this system. CONCLUSION:: The iCT navigation system is clinically feasible for thoraco-lumbar pedicle screw surgery. It provides high-level safety and accuracy, as well as ease of screw revision when required.
authors.affiliation: *Departments of Neurosurgery †Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chia-Yi Center ‡Chang Gung Institute of Technology, Chang Gung University, Chiayi §College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Ming-Hsueh
authors.initials: MH
authors.lastname: Lee
authors.forename: Martin Hsiu-Chu
authors.initials: MH
authors.lastname: Lin
authors.forename: Hsu-Huei
authors.initials: HH
authors.lastname: Weng
authors.forename: Wan-Chun
authors.initials: WC
authors.lastname: Cheng
authors.forename: Yuan-Hsiung
authors.initials: YH
authors.lastname: Tsai
authors.forename: Ting-Chung
authors.initials: TC
authors.lastname: Wang
authors.forename: Jen-Tsung
authors.initials: JT
authors.lastname: Yang