Placement of pedicle screws using three-dimensional fluoroscopy-based navigation in lumbar vertebrae with axial rotation |
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Authors: | Wei Tian Zhao Lang |
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Institution: | (1) Department of Spine Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, China |
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Abstract: | Despite potential advantages of three-dimensional fluoroscopy-based navigation, there still remain a lot of controversies
about the indications of this technology, especially whether it is worthy of being used in placement of pedicle screws in
lumbar spine. However, according to the inconsistent conclusions reported in the literature and our experiences, the traditional
method relying on anatomical landmarks and fluoroscopic views to guide lumbar pedicle screw insertion is unable to meet the
requirement of precise screw placement. Based on our observation, screw malposition seems to occur concomitant with vertebral
axial rotation which is a ubiquitous phenomenon. Three-dimensional fluoroscopy-based navigation can provide the most valuable
axial images in real-time, so it may be useful for placement of pedicle screws in lumbar spine. This study was intended to
evaluate the effect of axial rotation of lumbar vertebrae on the accuracy of pedicle screw placement using the traditional
method, as well as assess the value of three-dimensional fluoroscopy-based navigation in improving the accuracy. Sixteen lumbar
simulation models at different degrees of axial rotation (0°, 5°, 10°, and 20°), with every four assigned the same degree,
were equally divided into two groups (traditional method group and three-dimensional fluoroscopy-based navigation group).
Random placement of pedicle screws was carried out, followed by CT scan postoperatively. Then the outer pedicle cortex contours
were depicted from reconstructed sectional pedicle images using Photoshop. The accuracy of pedicle screw placement was evaluated
by determining the interrelationship between screw trajectory and pedicle cortex (quality), and measuring the shortest distance
from pedicle screw axis to outer cortex of the pedicle (quantity). Eighty pedicle screws were implanted, respectively, in
each group. In traditional method group, statistical difference existed in the accuracy of pedicle screw placement at different
axial rotational degrees (P < 0.05). With degrees increasing, the accuracy declined. The accuracy of three-dimensional fluoroscopy-based navigation group
was higher than traditional method group in vertebrae with axial rotation (P < 0.01). In qualitative evaluation, the accuracy of the two methods had statistical difference when the degree was 20°, and
in quantitative evaluation, statistical difference existed in 5°, 10°, and 20° of vertebral axial rotation. |
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Keywords: | Lumbar spine Pedicle screw Vertebral rotation Three-dimensional fluoroscopy-based navigation Accuracy |
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