title: Navigated pedicle screw placement using computed tomographic data in dorsolumbar fractures.
abstract: BACKGROUND
  Computed tomographic (CT) based navigation is a technique to improve the accuracy of pedicle screw placement. It is believed to enhance accuracy of pedicle screw placement, potentially avoiding complications arising due to pedicle wall breach. This study aims to assess the results of dorsolumbar fractures operated by this technique.
  
  
  METHODS
  Thirty consecutive skeletally mature patients of fractures of dorsolumbar spine (T9-L5) were subjected to an optoelectronic navigation system. All patients were thoroughly examined for neurological deficit. The criterion for instability were either a tricolumnar injury or presence of neurological deficit or both. Patients with multilevel fractures and distorted spine were excluded from study. Time taken for insertion of each pedicle screw was recorded and placement assessed with a postoperative CT scan using Laine's grading system.
  
  
  RESULTS
  Only one screw out of a total of 118 screws was misplaced with a Laine's Grade 5 placement, showing a misplacement rate of 0.847%. Average time for matching was 7.8 min (range 5-12 min). Average time taken for insertion of a single screw was 4.19 min (range 2-8 min) and total time for all screws after exposure was 34.23 min (range 24-45 min) for a four screw construct. No neurovascular complications were seen in any of the patients postoperatively and in subsequent followup of 1-year duration.
  
  
  CONCLUSIONS
  CT-based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9-L5), however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries. Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.
authors.affiliation: Department of Orthopaedic Surgery, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kapoor
authors.affiliation: Department of Orthopaedics, Postgraduate Institute, Chandigarh, India.
authors.forename: Rajbahadur
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Orthopaedics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Garg
authors.affiliation: Department of Orthopaedics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India.
authors.forename: Rohit
authors.initials: R
authors.lastname: Jindal
authors.affiliation: Department of Orthopaedics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Orthopaedics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India.
authors.forename: Anshul
authors.initials: A
authors.lastname: Goe
keywords: Dorso lumbar spine; Laine's grading; Spine; bone screws; navigation; neuronavigation; paired point matching; spinal fractures; tomography