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Intraoperative Computed Tomography Versus 3D C-Arm Imaging for Navigated Spinal Instrumentation
Nils Hecht1, Hadya Yassin1, Marcus Czabanka1
1Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Spine
|April 4, 2017
Summary
Intraoperative CT (iCT) and 3D C-arm navigation offer comparable accuracy for spinal pedicle screw placement. However, iCT provides superior screw visualization and accuracy in the cervical and thoracic spine.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Medical Imaging
Background:
- Navigated pedicle screw implantation improves accuracy.
- The benefit of intraoperative computed tomography (iCT) over 3D C-arm imaging for navigated spinal instrumentation is debated.
Purpose of the Study:
- To compare the accuracy and limitations of intraoperative computed tomography (iCT)-based versus 3D C-arm-based spinal navigation for posterior pedicle screw implantation.
Main Methods:
- Prospective case-series study with retrospective analysis.
- 1527 pedicle screws implanted in 260 patients using iCT or 3D C-arm navigation.
- Intraoperative and final screw accuracy assessed via imaging; revisions performed as needed.
Main Results:
- Both iCT and 3D C-arm navigation showed comparable overall intraoperative accuracy (94.7% vs 89.4%) and final accuracy (95.4% vs 91.6%).
- iCT allowed immediate assessment of all screws, while 39/308 screws with 3D C-arm were not clearly assessable.
- iCT-based navigation demonstrated significantly higher final accuracy in the cervical (99.5% vs 88.9%) and thoracic (97.7% vs 88.8%) regions.
Conclusions:
- Both iCT and 3D C-arm navigation provide high accuracy for pedicle screw placement.
- Intraoperative 3D C-arm imaging alone may limit immediate screw assessability and placement accuracy in the cervical-thoracic spine.