Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Medical Imaging

Background:

• Pedicle screws are crucial for correcting spinal deformities in children.
• Intraoperative computed tomography (CT) and navigation systems offer advanced methods for pedicle screw placement and verification.
• These technologies supplement traditional fluoroscopy and anatomical techniques.

Purpose of the Study:

• To assess the accuracy of open pedicle screw placement in pediatric patients.
• To evaluate the efficacy of intraoperative CT and 3D image-guided navigation for this procedure.
• To compare pediatric screw placement accuracy with adult data and historical pediatric data.

Main Methods:

• A retrospective cohort study analyzed 984 pedicle screws placed in 50 pediatric patients between 2007 and 2010.
• Intraoperative CT (O-arm) and a computerized navigation system (Stealth) were used for screw placement.
• Accuracy was determined by the need for screw redirection or removal based on intraoperative CT imaging.

Main Results:

• The study achieved a 96.4% accuracy rate for pediatric pedicle screw placement, with 3.6% of screws requiring revision (redirection or removal).
• No pediatric patients required reoperation due to screw malposition.
• Adult patients showed a higher accuracy rate of 98.2% (1.8% revision rate), but the pediatric accuracy significantly exceeded that of non-navigated screws in children (94.9% accuracy).

Conclusions:

• Intraoperative CT and 3D navigation provide a 96.4% accuracy rate for pediatric pedicle screw placement.
• This navigated technique demonstrates superior accuracy compared to non-navigated methods in pediatric spinal deformity correction.
• The findings support the use of these advanced imaging and navigation technologies in pediatric spine surgery.