title: [Percutaneous minimally invasive pedicle screw fixation for cervical fracture using intraoperative three-dimensional fluoroscopy-based navigation].
abstract: OBJECTIVE
  To retrospectively assess the feasibility and safety of percutaneous minimally invasive pedicle screw fixation for cervical fracture using intraoperative three-dimensional fluoroscopy-based navigation.
  
  
  METHODS
  Thirty patients admitted from April 2012 to May 2014 in Beijing Jishuitan Hospital with cervical fracture underwent pedicle screw fixation using intraoperative three-dimensional fluoroscopy-based navigation, with 8 patients using minimally invasive technique (CAOS-MIS group), and the other 22 patients using conventional open approach (CAOS-open group). Operative time, blood loss and postoperative neurovascular complications were recorded. Screw positions were studied by postoperative CT scan. All patients were followed up for at least 6 months. Neck visual analogue score (VAS) and American Spinal Injury Association (ASIA) classification were evaluated preoperatively and at 6-month follow-up. Independent-sample t test and Chi-Square test were used for statistical analysis.
  
  
  RESULTS
  Operation time was (139 ± 18) minutes and blood loss was (73 ± 40) ml in CAOS-MIS group and correspondingly (154 ± 42) minutes and (296 ± 171) ml in CAOS-open group. The blood loss in CAOS-MIS group was significantly lower than that in CAOS-open group (t = 5.695, P < 0.01). No screw-related injury to nerve or vertebral artery was observed. Thirty-four screws were placed in CAOS-MIS group with 28 screws (82.4%) classified as Grade I, meanwhile in CAOS-open group 108 screws were placed with 96 screws (88.9%) classified as Grade I. There was no statistical difference between the two groups (χ² = 0.998, P > 0.01). VAS score showed no statistical difference preoperatively (t = 0.334, P > 0.01), however statistical difference existed at 6 months follow-up (t = 4.111, P < 0.01) with (0.4 ± 0.5) in CAOS-MIS group and (1.5 ± 0.7) in CAOS-open group. There were 1 patient from class B to improve to D, 1 case from D to E in CAOS-MIS group, and 1 patient from class A to improve to B, 1 case from B to D, 2 cases from C to D, 3 cases from D to E in CAOS-open group 6 months after surgery. Cervical X-ray demonstrated fractures healed well in all cases at 6 months follow-up.
  
  
  CONCLUSIONS
  It is feasible and safe for percutaneous minimally invasive pedicle screw fixation for cervical fracture using intraoperative three-dimensional fluoroscopy-based navigation, which can also decreases the incidence of postoperative neck pain.
authors.affiliation: Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Lang
authors.affiliation: Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China; Email: tianweijst@vip.163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Tian
authors.affiliation: Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Yuan
authors.affiliation: Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
authors.forename: Da
authors.initials: D
authors.lastname: He
authors.affiliation: Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Yuan
authors.affiliation: Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
authors.forename: Yuzhen
authors.initials: Y
authors.lastname: Sun
mesh_terms: D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D061646:Operative Time; D019637:Orthopedic Procedures / Q000379:methods*; D065289:Pedicle Screws; D011183:Postoperative Complications; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome