Does Navigation Improve Pedicle Screw Placement Accuracy? Comparison Between Navigated and Non-navigated Percutaneous...

Area of Science:

• Spinal Surgery
• Medical Imaging
• Surgical Navigation

Background:

• Transpedicular screw insertion is a common procedure in spinal fixation.
• Accuracy and safety of screw placement are critical for successful outcomes.
• Standard techniques include open free-hand and percutaneous fluoroscopy-guided methods.

Purpose of the Study:

• To compare the accuracy and safety of transpedicular screw insertion using preoperative computed tomography (CT)-based navigation versus standard techniques.
• To evaluate four different techniques: open navigated, open free-hand, percutaneous CT-based navigation, and percutaneous fluoroscopy-guided.

Main Methods:

• A comparative study involving 203 patients undergoing thoracic and lumbar fixation.
• Four groups were analyzed: open navigated (218 screws), open free-hand (220 screws), percutaneous CT-based navigation (230 screws), and percutaneous fluoroscopy-guided (236 screws).
• Screw positions were evaluated on CT scans using a four-point grading scale for breach severity. Statistical analysis included ANOVA and LSD tests.

Main Results:

• Significant accuracy differences were found between open CT-based navigation and percutaneous CT-based navigation (P=0.0263).
• Open CT-based navigation also showed significant accuracy differences compared to percutaneous fluoroscopy-guided techniques (P=0.0258).
• A notable difference in anterior misplacement was observed between open CT-based navigation and percutaneous fluoroscopy-guided techniques (P=0.0153).

Conclusions:

• CT-based navigation techniques offer superior accuracy for transpedicular screw insertion.
• The advantages of navigation are evident in both open and percutaneous surgical approaches.
• Navigation systems enhance precision, potentially improving patient safety in spinal fixation surgeries.