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Minimally invasive pedicle screw fixation utilizing O-arm fluoroscopy with computer-assisted navigation: Feasibility, technique, and preliminary results.

Park P, Foley KT, Cowan JA, Marca FL - Surg Neurol Int (2010)

Bottom Line: We present our technique and review the results from a cohort of patients who underwent minimally invasive lumbar pedicle screw placement utilizing the O-arm imaging unit in conjunction with the StealthStation Treon System.All breaches were graded as 0-2 mm and were asymptomatic.In the remaining three patients, post-instrumentation O-arm imaging did not demonstrate pedicle screw misplacement.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA.

ABSTRACT

Background: Pedicle screw misplacement is relatively common, with reported rates ranging up to 42%. Although computer-assisted image guidance (CaIG) has been shown to improve accuracy in open spinal surgery, its use in minimally invasive procedures has not been as well evaluated. We present our technique and review the results from a cohort of patients who underwent minimally invasive lumbar pedicle screw placement utilizing the O-arm imaging unit in conjunction with the StealthStation Treon System.

Methods: A retrospective review of patients who underwent minimally invasive pedicle screw fixation with CaIG was performed. Eleven consecutive patients were identified and all were included. Nine patients underwent a single-level transforaminal lumbar interbody fusion. Two patients underwent multi-level fusion. Inaccurate pedicle screw placement was determined by postoperative computed tomography (CT) and graded as 0-2, 2-4, 4-6, or 6-8 mm.

Results: A total of 52 screws were placed. Forty screws were inserted in eight patients who had postoperative CT, and a misplacement rate of 7.5% was noted including one lateral and two medial breaches. All breaches were graded as 0-2 mm and were asymptomatic. In the remaining three patients, post-instrumentation O-arm imaging did not demonstrate pedicle screw misplacement.

Conclusion: Although this initial study evaluates a relatively small number of patients, minimally invasive pedicle screw fixation utilizing the O-arm and StealthStation for CaIG appears to be safe and accurate.

No MeSH data available.


Axial image from the O-arm showing adequate positioning of pedicle screws
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Figure 0005: Axial image from the O-arm showing adequate positioning of pedicle screws

Mentions: Twelve additional pedicle screws were placed in three patients who did not undergo postoperative spine protocol CT imaging. One patient had a non-spine protocol CT, which upon review, did not show evidence of screw misplacement. In the remaining two patients, the O-arm was used to check screw placement at the end of the procedure. Although not of the same diagnostic quality as a true CT scanner, the O-arm images obtained did not demonstrate significant medial or lateral screw misplacement [Figure 5]. None of these three patients had clinical evidence of a radiculopathy.


Minimally invasive pedicle screw fixation utilizing O-arm fluoroscopy with computer-assisted navigation: Feasibility, technique, and preliminary results.

Park P, Foley KT, Cowan JA, Marca FL - Surg Neurol Int (2010)

Axial image from the O-arm showing adequate positioning of pedicle screws
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2958329&req=5

Figure 0005: Axial image from the O-arm showing adequate positioning of pedicle screws
Mentions: Twelve additional pedicle screws were placed in three patients who did not undergo postoperative spine protocol CT imaging. One patient had a non-spine protocol CT, which upon review, did not show evidence of screw misplacement. In the remaining two patients, the O-arm was used to check screw placement at the end of the procedure. Although not of the same diagnostic quality as a true CT scanner, the O-arm images obtained did not demonstrate significant medial or lateral screw misplacement [Figure 5]. None of these three patients had clinical evidence of a radiculopathy.

Bottom Line: We present our technique and review the results from a cohort of patients who underwent minimally invasive lumbar pedicle screw placement utilizing the O-arm imaging unit in conjunction with the StealthStation Treon System.All breaches were graded as 0-2 mm and were asymptomatic.In the remaining three patients, post-instrumentation O-arm imaging did not demonstrate pedicle screw misplacement.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA.

ABSTRACT

Background: Pedicle screw misplacement is relatively common, with reported rates ranging up to 42%. Although computer-assisted image guidance (CaIG) has been shown to improve accuracy in open spinal surgery, its use in minimally invasive procedures has not been as well evaluated. We present our technique and review the results from a cohort of patients who underwent minimally invasive lumbar pedicle screw placement utilizing the O-arm imaging unit in conjunction with the StealthStation Treon System.

Methods: A retrospective review of patients who underwent minimally invasive pedicle screw fixation with CaIG was performed. Eleven consecutive patients were identified and all were included. Nine patients underwent a single-level transforaminal lumbar interbody fusion. Two patients underwent multi-level fusion. Inaccurate pedicle screw placement was determined by postoperative computed tomography (CT) and graded as 0-2, 2-4, 4-6, or 6-8 mm.

Results: A total of 52 screws were placed. Forty screws were inserted in eight patients who had postoperative CT, and a misplacement rate of 7.5% was noted including one lateral and two medial breaches. All breaches were graded as 0-2 mm and were asymptomatic. In the remaining three patients, post-instrumentation O-arm imaging did not demonstrate pedicle screw misplacement.

Conclusion: Although this initial study evaluates a relatively small number of patients, minimally invasive pedicle screw fixation utilizing the O-arm and StealthStation for CaIG appears to be safe and accurate.

No MeSH data available.