TY - JOUR
T1 - Intraoperative CT-guided navigation versus fluoroscopy for percutaneous pedicle screw placement in 192 patients: a comparative analysis
AU - La Rocca, Giuseppe
AU - Mazzucchi, Edoardo
AU - Pignotti, Fabrizio
AU - Nasto, Luigi Aurelio
AU - Galieri, Gianluca
AU - Olivi, Alessandro
AU - De Santis, Vincenzo
AU - Rinaldi, Pierluigi
AU - Pola, Enrico
AU - Sabatino, Giovanni
PY - 2022
Y1 - 2022
N2 - Background: Percutaneous pedicle screw (PPS) placement is a key step in several minimally invasive spinal surgery (MISS) procedures. Traditional technique for PPS makes use of C-arm fluoroscopy assistance (FA). More recently, newer intraoperative imaging techniques have been developed for PPS, including CT-guided navigation (CTNav). The aim of this study was to compare FA and CTNav techniques for PPS with regard to accuracy, complications, and radiation dosage. Materials and methods: A total of 192 patients with degenerative lumbar spondylolisthesis and canal stenosis who underwent MISS posterior fusion ± interbody fusion through transforaminal approach (TLIF) were retrospectively reviewed. Pedicle screws were placed percutaneously using either standard C-arm fluoroscopy guidance (FA group) or CT navigation (CTNav group). Intraoperative effective dose (ED, mSv) was measured. Screw placement accuracy was assessed postoperatively on a CT scan using Gertzbein and Robbins classification (grades A–E). Oswestry disability index (ODI) and visual analog scale (VAS) scores were compared in both groups before and after surgery. Results: A total of 101 and 91 procedures were performed with FA (FA group) and CTNav approach (CTNav group), respectively. Median age was 61 years in both groups, and the most commonly treated level was L4–L5. Median ED received from patients was 1.504 mSv (0.494–4.406) in FA technique and 21.130 mSv (10.840–30.390) in CTNav approach (p < 0.001). Percentage of grade A and B screws was significantly higher for the CTNav group (96.4% versus 92%, p < 0.001), whereas there were 16 grade E screws in the FA group and 0 grade E screws in the CTNav group (p < 0.001). A total of seven and five complications were reported in the FA and CTNav group, respectively (p = 0.771). Conclusions: CTNav technique increases accuracy of pedicle screw placement compared with FA technique without affecting operative time. Nevertheless, no significant difference was noted in terms of reoperation rate due to screw malpositioning between CTNav and FA techniques. Radiation exposure of patients was significantly higher with CTNav technique. Level of Evidence: Level 3.
AB - Background: Percutaneous pedicle screw (PPS) placement is a key step in several minimally invasive spinal surgery (MISS) procedures. Traditional technique for PPS makes use of C-arm fluoroscopy assistance (FA). More recently, newer intraoperative imaging techniques have been developed for PPS, including CT-guided navigation (CTNav). The aim of this study was to compare FA and CTNav techniques for PPS with regard to accuracy, complications, and radiation dosage. Materials and methods: A total of 192 patients with degenerative lumbar spondylolisthesis and canal stenosis who underwent MISS posterior fusion ± interbody fusion through transforaminal approach (TLIF) were retrospectively reviewed. Pedicle screws were placed percutaneously using either standard C-arm fluoroscopy guidance (FA group) or CT navigation (CTNav group). Intraoperative effective dose (ED, mSv) was measured. Screw placement accuracy was assessed postoperatively on a CT scan using Gertzbein and Robbins classification (grades A–E). Oswestry disability index (ODI) and visual analog scale (VAS) scores were compared in both groups before and after surgery. Results: A total of 101 and 91 procedures were performed with FA (FA group) and CTNav approach (CTNav group), respectively. Median age was 61 years in both groups, and the most commonly treated level was L4–L5. Median ED received from patients was 1.504 mSv (0.494–4.406) in FA technique and 21.130 mSv (10.840–30.390) in CTNav approach (p < 0.001). Percentage of grade A and B screws was significantly higher for the CTNav group (96.4% versus 92%, p < 0.001), whereas there were 16 grade E screws in the FA group and 0 grade E screws in the CTNav group (p < 0.001). A total of seven and five complications were reported in the FA and CTNav group, respectively (p = 0.771). Conclusions: CTNav technique increases accuracy of pedicle screw placement compared with FA technique without affecting operative time. Nevertheless, no significant difference was noted in terms of reoperation rate due to screw malpositioning between CTNav and FA techniques. Radiation exposure of patients was significantly higher with CTNav technique. Level of Evidence: Level 3.
KW - CT navigation
KW - Degenerative spondylolisthesis
KW - Low-back-pain surgery
KW - Minimally invasive spine surgery
KW - Percutaneous pedicle screws
KW - Radiation exposure
KW - CT navigation
KW - Degenerative spondylolisthesis
KW - Low-back-pain surgery
KW - Minimally invasive spine surgery
KW - Percutaneous pedicle screws
KW - Radiation exposure
UR - http://hdl.handle.net/10807/227409
U2 - 10.1186/s10195-022-00661-8
DO - 10.1186/s10195-022-00661-8
M3 - Article
SN - 1590-9921
VL - 23
SP - 1
EP - 7
JO - Journal of Orthopaedics and Traumatology
JF - Journal of Orthopaedics and Traumatology
ER -