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Improved accuracy of pedicle screw insertion with computer-assisted surgery. A prospective clinical trial of 30
T Laine1, D Schlenzka, K Mäkitalo
1ORTON Orthopaedic Hospital, Invalid Foundation, Helsinki, Finland.
Study Design:
A prospective clinical trial was done to study the accuracy of pedicle screw placement in 30 consecutive computer-assisted orthopedic surgeries.
Objectives:
To determine the accuracy and clinical applicability of this new method for pedicle screw insertion.
Summary Of Background Data:
Conventional screw insertion techniques have been associated with high pedicle screw malplacement rates in cadaver studies and clinical studies with postoperative computed tomography evaluation.
Methods:
Thirty transpedicular, low-back, titanium instrumentations were performed with computer-assisted orthopedic surgery. The accuracy of screw placement was evaluated using a sophisticated computed tomography protocol.
Results:
The total number of pedicle screws was 174. Of these, 139 (79.9%) could be inserted with computer-assisted orthopedic surgery. The malplacement rate of computer-assisted orthopedic surgery screws was 4.3%. In screws that were not inserted by computer-assisted orthopedic surgery, the malplacement rate was 14.3%. One malplaced screw that had not been inserted with computer-assisted orthopedic surgery caused L4 root paresis.
Conclusions:
The accuracy of pedicle screw placement using computer-assisted surgery proved to be superior to the accuracy obtained when using conventional techniques.