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Computer-assisted spine surgery.

P Merloz¹, J Tonetti, L Pittet

¹University Department of Orthopaedic Surgery, CHU A. Michallon, Grenoble, France.

Computer Aided Surgery : Official Journal of the International Society for Computer Aided Surgery

|June 24, 1999

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Computer-assisted spinal surgery significantly improves pedicle screw placement accuracy. This new technique reduced incorrect screw insertions from 44% with manual methods to 9%, enhancing patient safety in spinal procedures.

Area of Science:

Spinal Surgery
Medical Imaging
Computer-Assisted Surgery

Background:

Transpedicle screw insertion is prone to complications, with previous studies reporting incorrect placement rates between 10% and 40%.
Ensuring accurate pedicle screw placement is crucial for preventing neurological, vascular, and mechanical complications during spinal procedures.

Purpose of the Study:

To evaluate the reliability and accuracy of a novel computer-assisted technique for pedicle screw insertion in the thoracolumbar spine.
To compare the efficacy of computer-assisted pedicle screw insertion against traditional manual techniques.

Main Methods:

A prospective study involving 128 pedicle screw insertions (64 computer-assisted, 64 manual) in the thoracolumbar region.
The computer-assisted technique integrated preoperative computed tomography (CT) imaging with intraoperative passive navigation.

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Postoperative radiographs and CT scans were used to measure screw position accuracy relative to pedicle anatomy.

Main Results:

The computer-assisted technique resulted in incorrect screw placement in 9% (6/64) of cases, a significant improvement over the 44% (28/64) rate with manual insertion.
Intraoperative accuracy with the computer-assisted method was consistently better than 1 mm.
Cortex penetration in the computer-assisted group was attributed to surgeon error in data acquisition, not system failure.

Conclusions:

The combined preoperative CT imaging and intraoperative navigation technique offers good accuracy and reliability for pedicle screw insertion.
This computer-assisted approach substantially reduces the rate of misplaced pedicle screws compared to manual insertion.
Further refinement in surgical data acquisition may further enhance the already impressive outcomes of this technology.