title: The Use of Neuronavigation and Intraoperative Imaging in Spinal Stabilization Surgery.
abstract: OBJECTIVE
  Misplacement of pedicle screw is the serious complication of spinal surgeries. Intraoperative imaging techniques and navigation systems are currently in use for the prevention of this complication. The aim of this study was to document the results of our experience with the navigation and intraoperative imaging technique and to share our experience with our colleagues.
  
  
  METHODS
  Between 2011 and 2014, one hundred and two patients underwent instrumented spinal surgery while using intraoperative computed tomography (iCT) and a navigation system. All patients had a CT scan performed no more than three days postoperatively to confirm adequate placement of the screws. The accuracy of pedicle screw placement was assessed by postoperative CT scan. Pedicle violations were graded according to an established classification system.
  
  
  RESULTS
  In the 36-month period, a total of 610 screws in 102 patients were evaluated. Stabilization surgery was performed in the lumbosacral region in 51 (50%) patients, lumbar region in 35 (34.31%) patients, cervical region in 5 (4.9%) patients, thoracolumbar region in 7 (6.86%) patients and thoracic region in 4 (3.92%) patients. Of the 610 screws, 396 (64.91%) were placed in lumbar, 66 (10.81%) in thoracic, 106 (17.37%) in sacral and 42 (6.8%) in cervical vertebrae. Of the 610 screws, 599 screws (98.18%) were placed without a breach. Grade 1 breaches occurred in 8 screws (1.31%), Grade 2 breaches occurred in 2 screws (0.32%), and Grade 3 breaches in 1 screw (0.16%). No dural defect or neurological deficit occurred after the surgeries.
  
  
  CONCLUSIONS
  The use of an iCT scan associated with a navigation system increases the accuracy of pedicle screw placement. This system protects the surgical team from fluoroscopic radiation exposure and the patient from the complications of screw misplacement and repeated surgeries.
authors.affiliation: Gulhane Military Medical Academy, Department of Neurosurgery, Ankara, Turkey.
authors.forename: Ozkan
authors.initials: O
authors.lastname: Tehli
authors.forename: Ferhat
authors.initials: F
authors.lastname: Harman
authors.forename: Caglar
authors.initials: C
authors.lastname: Temiz
authors.forename: Yunus
authors.initials: Y
authors.lastname: Kacar
authors.forename: Burak
authors.initials: B
authors.lastname: Kazanci
authors.forename: Mehmet
authors.initials: M
authors.lastname: Daneyemez
authors.forename: Ilker
authors.initials: I
authors.lastname: Solmaz
authors.forename: Cahit
authors.initials: C
authors.lastname: Kural
mesh_terms: D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*; D038361:Neuronavigation / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D065289:Pedicle Screws; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed