Cervical pedicle screw placement using intraoperative computed tomography imaging with a mobile scanner gantry

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Medical Imaging

Background:

• Cervical pedicle screw (CPS) placement is critical for spinal fixation.
• Traditional fluoroscopy-guided placement has limitations in accuracy.
• Intraoperative imaging can potentially improve surgical outcomes.

Purpose of the Study:

• To evaluate the accuracy of a novel cervical pedicle screw (CPS) placement technique using a mobile multi-detector computed tomography (CT) system.
• To compare the accuracy of this technique with historical controls using fluoroscopy alone.

Main Methods:

• Prospective enrollment of 48 patients undergoing cervical fixation with CPS.
• Intraoperative CT imaging to verify pedicle probing accuracy and guide trajectory modification.
• Postoperative CT imaging for accuracy assessment and comparison with a fluoroscopy-only control group (22 patients).

Main Results:

• A total of 193 CPSs were inserted.
• Intraoperative CT identified inaccurate initial probings in 12.4% of cases, necessitating trajectory modification.
• Postoperative CT revealed 92.7% accurate CPS placement, significantly higher than the 80.9% in the control group.
• Only 1.0% of screws showed grade 2 misplacement with no neurovascular complications.

Conclusions:

• Cervical pedicle screw (CPS) placement using a mobile CT system is a safe and effective technique.
• This method significantly improves the accuracy of CPS insertion.
• The technique helps prevent serious neurovascular complications associated with CPS placement.