title: Incidence and risk factors for the misplacement of pedicle screws in scoliosis surgery assisted by O-arm navigation-analysis of a large series of one thousand, one hundred and forty five screws.
abstract: To assess the accuracy of O-arm-navigation-based pedicle screw placement in scoliosis surgery and identify the potential risk factors for the misplacement of pedicle screws.
  
  
  
  One hundred forty four scoliosis patients treated with O-arm-navigation-based pedicle screw instrumentation were enrolled, and 1145 pedicle screws implanted in the apical region of the curves were retrospectively reviewed for accuracy according to post-operative CT images. The potential risk factors and independent predictive factor(s) for the misplaced screws were identified statistically.
  
  
  
  The overall malpositioning rate of pedicle screw was 9.8%; 54.5% of which were misplaced laterally. Univariate and multivariate logistic regression analysis of clinical and surgical treatment variables indicated that patients with congenital scoliosis (CS) [OR: 1.489 (95% CI: 1.002-2.213; P = 0.035)] and neurofibromatosis type I (NF-1) [OR: 1.785 (95% CI: 1267-2.045; P = 0.026)], middle-thoracic spine [OR: 1.661 (95% CI: 1.107-2.481; P = 0.021)], the concave pedicles [OR: 1.527 (95% CI: 1.020-2.285; P = 0.019)], and the segments three levels away from the tracker [OR: 3.522 (95% CI: 2.357-5.263; P = 0.001)] were independently associated with pedicle screw misplacement.
  
  
  
  O-arm-assisted navigation does improve the accuracy and safety of pedicle screw placement in scoliosis surgery. However, unavoidable screw malpositioning remained, which occurred significantly more often in patients with CS and NF-1, in middle-thoracic spine, in the concave pedicles, and in the segments three levels away from the tracker.
authors.affiliation: Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China.|Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road, No. 321, Nanjing, Jiangsu Province, 210008, China.
authors.forename: Mengran
authors.initials: M
authors.lastname: Jin
authors.affiliation: Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road, No. 321, Nanjing, Jiangsu Province, 210008, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road, No. 321, Nanjing, Jiangsu Province, 210008, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road, No. 321, Nanjing, Jiangsu Province, 210008, China.
authors.forename: Huang
authors.initials: H
authors.lastname: Yan
authors.affiliation: Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road, No. 321, Nanjing, Jiangsu Province, 210008, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Han
authors.affiliation: Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road, No. 321, Nanjing, Jiangsu Province, 210008, China. drzhuzhezhang@126.com.
authors.forename: Zezhang
authors.initials: Z
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D015994:Incidence; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009456:Neurofibromatosis 1 / Q000150:complications; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D065289:Pedicle Screws / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000151:congenital / Q000209:etiology / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Accuracy assessment; O-arm navigation; Risk factors; Scoliosis