Pedicle screw placement accuracy in thoracic and lumbar spinal surgery with a patient-matched targeting guide: a cadaveric study.
OBJECTIVE
Pedicle screw placement is an increasingly common procedure for the correction of spine degenerative disease, deformity and trauma. However, screw placement is demanding, with complications resulting from inaccurate screw placement. While several different techniques have been developed to improve accuracy, they all have their limitations.


METHODS
We examined the MySpine (Medacta International SA, Castel San Pietro, CH) patient-matched pedicle targeting guide in three cadaveric spine specimens operated on by three surgeons. A three-dimensional (3D) preoperative plan was constructed from spinal computed tomography scans, from which individualised guides were developed for the placement of Medacta Unconstrained Screw Technology pedicle screws. Following screw placement, the 3D positioning of the screws was compared to the preoperative plan against a series of pre-defined criteria.


RESULTS
Of 46 inserted screws eligible for assessment, 91.3 % were fully inside the pedicle. There were no cases of Grade B (2-4 mm) or C (>4 mm) pedicle perforation. The mean deviation between the planned and actual screw position at the midpoint of the pedicle was 0.70 mm, the mean horizontal deviation was 0.60 mm and the mean vertical deviation was 0.77 mm. The mean angular deviation in the sagittal plane was 1.74°, versus 1.32° in the transverse plane. The mean deviation in screw depth was 1.55 mm. On all measures, the accuracy of screw placement was within the predefined criteria.


CONCLUSIONS
Our cadaver study indicates that pedicle screw placement with the system is accurate and should be investigated in larger in vitro and in vivo studies.
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Claudio
C
Lamartina
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. dott.cecchinato@gmail.com.
Riccardo
R
Cecchinato
Neuro und Wirbelsäulenzentrum Zentralschweiz, Lucerne, Switzerland.
Zsolt
Z
Fekete
Medacta International SA, 6874, Castel San Pietro, Switzerland.
Alberto
A
Lipari
Medacta International SA, 6874, Castel San Pietro, Switzerland.
Meinrad
M
Fiechter
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
P
P
Berjano
D006801:Humans; D021621:Imaging, Three-Dimensional; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D065289:Pedicle Screws; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
Patient-specific instrumentation; Pedicle screws; Spine; Surgery; Technique, in vitro