Placement of pedicle screws using different navigation systems. A laboratory trial with 12 spinal preparations

A well-known problem occurring with thoracolumbar spondylodesis is the perforation of pedicle screws through the pedicle wall. It occurs in up to 40% of the implanted screws. To reduce this problem, computed tomography (CT)-based navigation systems have been introduced, which allow the surgeon multidimensional control of the screw position in virtual reality and real time during insertion. In the recent past, fluoroscopy-based navigation systems have also been built. We inserted 77 pedicle screws in human lumbar cadaveric spine specimens either without navigation, with CT-based navigation, or with fluoroscopy-based navigation. In the critical sizes of pedicles between 6.5 and 9 mm, we found the best results with CT-based navigation, but there was no significant difference between the three methods. The minimal pedicle and the screw diameters should be reported in every study on pedicle screw misplacement and spine navigation since they represent the most important factor in pedicle wall perforations.