title: Computer-aided surgery does not increase the accuracy of dorsal pedicle screw placement in the thoracic and lumbar spine: a retrospective analysis of 2,003 pedicle screws in a level I trauma center.
abstract: Study Design A retrospective analysis of a prospective database. Objective Meta-analyses suggest that computer-assisted systems can increase the accuracy of pedicle screw placement for dorsal spinal fusion procedures. The results of further meta-analyses report that in the thoracic spine, both the methods have comparable placement accuracy. These studies are limited due to an abundance of screw classification systems. The aim of this study was to assess the placement accuracy and potentially influencing factors of three-dimensionally navigated versus conventionally inserted pedicle screws. Methods This was a retrospective analysis of a prospective database at a level I trauma center of pedicle screw placement (computer-navigated versus traditionally placed) for dorsal spinal stabilizations. The cases spanned a 5.5-year study period (January 1, 2005, to June 30, 2010). The perforations of the pedicle were differentiated in three grades based on the postoperative computed tomography. Results The overall placement accuracy was 86% in the conventional group versus 79% in the computer-navigated group (grade 0). The computer-navigated procedures were superior in the lumbar spine and the conventional procedures were superior in the thoracic spine, but both failed to be of statistical significance. The level of experience of the performing surgeon and the patient's body mass index did not influence the placement accuracy. The only significant influence was the spinal segment: the higher the spinal level where the fusion was performed, the more likely the screw was displaced. Conclusions The computer-navigated and conventional methods are both safe procedures to place transpedicular screws at the traumatized thoracic and lumbar spine. At the moment, three-dimensionally based navigation does not significantly increase the placement accuracy.
authors.affiliation: Centre for Orthopaedic Trauma and Spine Surgery, Donau-Ries Hospital Donauwörth, Donauwörth, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kraus
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Weiskopf
authors.affiliation: Ulm University, Institute of Epidemiology and Medical Biometry, Ulm, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Dreyhaupt
authors.affiliation: Ulm University, Institute of Research in Rehabilitation Medicine, Bad Buchau, Germany.
authors.forename: Gert
authors.initials: G
authors.lastname: Krischak
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Ulm University, Ulm, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Gebhard
keywords: computer assisted pedicle screw placement; computer navigation; image based guidance; pedicle screw; spine
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