title: Intraoperative computed tomography navigation for transpedicular screw fixation to treat unstable thoracic and lumbar spine fractures: clinical analysis of a case series (CARE-compliant).
abstract: Transpedicular screw (TPS) fixation in unstable thoracic and lumbar (TL) spine fractures remains technically difficult because of destroyed anatomical landmarks, unstable gross segments, and discrepancies in anatomic orientation using conventional anatomic landmarks, fluoroscopic guidance, or computed tomography (CT)-based navigation. In this study, we evaluated the safety and accuracy of TPS placement under intraoperative computed tomography (iCT) navigation in managing unstable TL spine fractures.From 2010 to 2013, we retrospectively reviewed the Spine Operation Registry records of patients who underwent posterior instrumented fusion to treat unstable TL spine fractures via the iCT navigation system. An unstable spine fracture was identified as AO/Magerl classification type B or type C.In all, 316 screws in 37 patients with unstable TL spine fractures were evaluated and involved 7 thoracic, 23 thoracolumbar junctional, and 7 lumbar fractures. The accuracy of TPS positioning in the pedicle without breach was 98% (310/316). The average number of iCT scans per patient was 2.1 (range 2-3). The average total radiation dose to patients was 15.8 mSv; the dose per single level exposure was 2.7 mSv. The TPS intraoperative revision rate was 0.6% (2/316) and no neurovascular sequela was observed. TPS fixation using the iCT navigation system obtained a 98% accuracy in stabilizing unstable TL spine fractures. A malplaced TPS could be revised during real-time confirmation of the TPS position, and no secondary operation was required to revise malplaced screws.The iCT navigation system provides accurate and safe management of unstable TL spine fractures. In addition, operating room personnel, including surgeons and nurses, did not need to wear heavy lead aprons as they were not exposed to radiation.
authors.affiliation: From the Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi (C-YL, M-HW, Y-YL, C-CC, T-JH, RW-WH); Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung (T-JH); College of Medicine, Chang Gung University, Taoyuan (Y-YL, C-CC, T-JH, RW-WH); Department of Radiology, Chang Gung Memorial Hospital, Chiayi (C-HH); and Department of Orthopedic Surgery, Taipei Medical University Hospital, Taipei, Taiwan (T-JH).
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Lee
authors.forename: Meng-Huang
authors.initials: MH
authors.lastname: Wu
authors.forename: Yen-Yao
authors.initials: YY
authors.lastname: Li
authors.forename: Chin-Chang
authors.initials: CC
authors.lastname: Cheng
authors.forename: Chu-Hsiang
authors.initials: CH
authors.lastname: Hsu
authors.forename: Tsung-Jen
authors.initials: TJ
authors.lastname: Huang
authors.forename: Robert Wen-Wei
authors.initials: RW
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult