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Accuracy of image-guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing, part I: cervicothoracic spine.
Neurosurgery 2011; 69(4):782-95; discussion 795N

Abstract

BACKGROUND

Image-guided spinal instrumentation reduces the incidence of implant misplacement.

OBJECTIVE

To assess the accuracy of intraoperative computed tomography (iCT)-based neuronavigation (iCT-N).

METHODS

In 35 patients (age range, 18-87 years), a total of 248 pedicle screws were placed in the cervical (C1-C7) and upper and midthoracic (T1-T8) spine. An automated iCT registration sequence was used for multisegmental instrumentation, with the reference frame fixed to either a Mayfield head clamp and/or the most distal spinous process within the instrumentation. Pediculation was performed with navigated drill guides or Jamshidi cannulas. The angular deviation between navigated tool trajectory and final implant positions (evaluated on postinstrumentation iCT or postoperative CT scans) was calculated to assess the accuracy of iCT-N. Final screw positions were also graded according to established classification systems. Mean follow-up was 16.7 months.

RESULTS

Clinically significant screw misplacement or iCT-N failure mandating conversion to conventional technique did not occur. A total of 71.4% of patients self-rated their outcome as excellent or good at 12 months; 99.3% of cervical screws were compliant with Neo classification grades 0 and 1 (grade 2, 0.7%), and neurovascular injury did not occur. In addition, 97.8% of thoracic pedicle screws were assigned grades I to III of the Heary classification, with 2.2% grade IV placement. Accuracy of iCT-N progressively deteriorated with increasing distance from the spinal reference clamp but allowed safe instrumentation of up to 10 segments.

CONCLUSION

Image-guided spinal instrumentation using iCT-N with automated referencing allows safe, highly accurate multilevel instrumentation of the cervical and upper and midthoracic spine. In addition, iCT-N significantly reduces the need for reregistration in multilevel surgery.

Authors+Show Affiliations

Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria. Kai-Michael.Scheufler@uki.atNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

21552171

Citation

Scheufler, Kai-Michael, et al. "Accuracy of Image-guided Pedicle Screw Placement Using Intraoperative Computed Tomography-based Navigation With Automated Referencing, Part I: Cervicothoracic Spine." Neurosurgery, vol. 69, no. 4, 2011, pp. 782-95; discussion 795.
Scheufler KM, Franke J, Eckardt A, et al. Accuracy of image-guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing, part I: cervicothoracic spine. Neurosurgery. 2011;69(4):782-95; discussion 795.
Scheufler, K. M., Franke, J., Eckardt, A., & Dohmen, H. (2011). Accuracy of image-guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing, part I: cervicothoracic spine. Neurosurgery, 69(4), pp. 782-95; discussion 795. doi:10.1227/NEU.0b013e318222ae16.
Scheufler KM, et al. Accuracy of Image-guided Pedicle Screw Placement Using Intraoperative Computed Tomography-based Navigation With Automated Referencing, Part I: Cervicothoracic Spine. Neurosurgery. 2011;69(4):782-95; discussion 795. PubMed PMID: 21552171.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy of image-guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing, part I: cervicothoracic spine. AU - Scheufler,Kai-Michael, AU - Franke,Joerg, AU - Eckardt,Anke, AU - Dohmen,Hildegard, PY - 2011/5/10/entrez PY - 2011/5/10/pubmed PY - 2011/12/31/medline SP - 782-95; discussion 795 JF - Neurosurgery JO - Neurosurgery VL - 69 IS - 4 N2 - BACKGROUND: Image-guided spinal instrumentation reduces the incidence of implant misplacement. OBJECTIVE: To assess the accuracy of intraoperative computed tomography (iCT)-based neuronavigation (iCT-N). METHODS: In 35 patients (age range, 18-87 years), a total of 248 pedicle screws were placed in the cervical (C1-C7) and upper and midthoracic (T1-T8) spine. An automated iCT registration sequence was used for multisegmental instrumentation, with the reference frame fixed to either a Mayfield head clamp and/or the most distal spinous process within the instrumentation. Pediculation was performed with navigated drill guides or Jamshidi cannulas. The angular deviation between navigated tool trajectory and final implant positions (evaluated on postinstrumentation iCT or postoperative CT scans) was calculated to assess the accuracy of iCT-N. Final screw positions were also graded according to established classification systems. Mean follow-up was 16.7 months. RESULTS: Clinically significant screw misplacement or iCT-N failure mandating conversion to conventional technique did not occur. A total of 71.4% of patients self-rated their outcome as excellent or good at 12 months; 99.3% of cervical screws were compliant with Neo classification grades 0 and 1 (grade 2, 0.7%), and neurovascular injury did not occur. In addition, 97.8% of thoracic pedicle screws were assigned grades I to III of the Heary classification, with 2.2% grade IV placement. Accuracy of iCT-N progressively deteriorated with increasing distance from the spinal reference clamp but allowed safe instrumentation of up to 10 segments. CONCLUSION: Image-guided spinal instrumentation using iCT-N with automated referencing allows safe, highly accurate multilevel instrumentation of the cervical and upper and midthoracic spine. In addition, iCT-N significantly reduces the need for reregistration in multilevel surgery. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/21552171/Accuracy_of_image-guided_pedicle_screw_placement_using_intraoperative_computed_tomography-based_navigation_with_automated_referencing,_part_I:_cervicothoracic_spine L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/NEU.0b013e318222ae16 DB - PRIME DP - Unbound Medicine ER -