title: Are pedicle screw perforation rates influenced by registered or unregistered vertebrae in multilevel registration using a CT-based navigation system in the setting of scoliosis?
abstract: OBJECTIVE
  We developed a new multilevel registration technique for pedicle screw (PS) insertion that has the capability of registering three consecutive vertebrae simultaneously, using a reference frame set to one of the caudal vertebrae. PSs are inserted in the consecutive and adjacent one or two vertebrae. This study aimed to investigate the perforation rates of the registered and unregistered adjacent vertebrae and compare the perforation rate of the PS and insertion time per PS between the conventional and new techniques.
  
  
  METHODS
  Sixty-nine consecutive scoliosis patients who underwent PS insertion using multilevel registration were enrolled. The conventional and new techniques were used in 29 subjects, and in 40 subjects, respectively. The total numbers of PSs used were 375 and 492, respectively. Of the 492 PSs, 301 were inserted to the registered vertebrae and 191 were inserted to the unregistered adjacent vertebrae. The PS malposition on postoperative axial computed tomography was classified as grades 2 and 3 perforation, using the Rao classification. The perforation rate and insertion time per PS were compared between the conventional and new techniques.
  
  
  RESULTS
  The perforation rates did not significantly differ between the registered and unregistered vertebrae (10.3 vs. 6.3 %,), and between the new and conventional techniques (8.7 vs. 9.6 %). The insertion time per PS was significantly shorter in the new technique than in the conventional technique (3.9 ± 1.0 vs. 4.9 ± 1.3 min; p < 0.001).
  
  
  CONCLUSIONS
  The new technique may be less invasive and decrease operative time without compromising the accuracy of PS placement.
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan, masasimi@shinshu-u.ac.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shimizu
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.forename: Shota
authors.initials: S
authors.lastname: Ikegami
authors.forename: Shugo
authors.initials: S
authors.lastname: Kuraishi
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Futatsugi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D065289:Pedicle Screws / Q000009:adverse effects*; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000009:adverse effects* / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
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