title: Accuracy of 3D fluoroscopy-navigated anterior transpedicular screw insertion in the cervical spine: an experimental study.
abstract: The technique of pedicle screw stabilization is finding increasing popularity for use in the cervical spine. Implementing anterior transpedicular screws (ATPS) in cervical spine offers theoretical advantages compared to posterior stabilization. The goal of the current study was the development of a new setting for navigated insertion of ATPS, combining the advantage of reduced invasiveness of an anterior approach with the technical advantages of navigation.
  
  
  
  20 screws were implanted in levels C3 to C6 of four cervical spine models (SAWBONES(®) Cervical Vertebrae with Anterior Ligament) with the use of 3D fluoroscopy navigation system [Arcadis Orbic 3D, Siemens and VectorVision fluoro 3D trauma software (BrainLAB)]. The accuracy of inserted screws was analyzed according to postoperative CT scans and following the modified Gertzbein and Robbins classification.
  
  
  
  20 anterior pedicle screws were placed in four human cervical spine models. Of these, eight screws were placed in C3, two screws in C4, six screws in C5, and four screws in C6. 16 of 20 screws (80 %) reached a grade 1 level of accuracy according to the modified Gertzbein and Robbins Classification. Three screws (15 %) were grade 2, and one screw (5 %) was grade 3. Grade 4 and 5 positions were not evident. Summing grades 1 and 2 together as "good" positions, 95 % of the screws achieved this level. Only a single screw did not fulfill these criteria.
  
  
  
  The setting introduced in this study for navigated insertion of ATPS into cervical spine bone models is well implemented and shows excellent results, with an accuracy of 95 % (Gertzbein and Robbins grade 2 or better). Thus, this preliminary study represents a prelude to larger studies with larger case numbers on human specimens.
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany. jan.bredow@uk-koeln.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Bredow
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
authors.forename: Max Joseph
authors.initials: MJ
authors.lastname: Scheyerer
authors.affiliation: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Siedek
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
authors.forename: Lars Peter
authors.initials: LP
authors.lastname: Müller
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
authors.forename: Peer
authors.initials: P
authors.lastname: Eysel
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Stein
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008953:Models, Anatomic; D065289:Pedicle Screws; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Accuracy of screw insertion; Anterior transpedicular screws; Navigated screw insertion; Spine surgery
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