How Much Surface Registration Accuracy is Required Using Ct-based Navigation System in Adolescent Idiopathic Scoliosis Surgery?. Issue 3 (April 2019)

• Record Type: Journal Article
• Authors: Uehara, Masashi; Takahashi, Jun; Ikegami, Shota; Kuraishi, Shugo; Futatsugi, Toshimasa; Oba, Hiroki; Takizawa, Takashi; Munakata, Ryo; Koseki, Michihiko; Kato, Hiroyuki
• Is Part Of: Clinical spine surgery. Volume 32:Issue 3(2019)
• Publication Date: 2019-04
• Subjects: posterior spinal fusion -- pedicle screw fixation -- adolescent idiopathic scoliosis -- computed tomography-based navigation system -- perforation rate -- surface registration accuracy -- ROC curve analysis -- cut-off.; Spinal cord -- Diseases -- Periodicals; Spinal cord -- Surgery -- Periodicals; 617.56059
• DOI: 10.1097/BSD.0000000000000759
• Languages: English
• ISSNs: 2380-0186

Abstract

Abstract : Study Design: Retrospective, single-center, single-surgeon study. Objective: This study investigated screw perforation rate according to surface registration accuracy in pedicle screw fixation using a CT-based navigation system for adolescent idiopathic scoliosis (AIS). Summary of Background data: Posterior spinal fusion for scoliosis correction using pedicle screws is widely adopted but carries a risk of serious neurovascular or visceral structure events. To attempt to avoid these complications, we have been using a computed tomography (CT)-based navigation system during screw insertion, although insufficient surface registration accuracy may be a reason for some screw perforations. Methods: We evaluated 116 AIS patients (9 male and 107 females; mean±standard deviation age: 15.2±2.3 y) who had received pedicle screw fixation guided by a CT-based navigation system between August 2007 and December 2017. Screw perforation rate was evaluated in relation to surface registration accuracy and cut-off values were determined by receiver operating characteristic (ROC) curves. Results: A total of 1553 pedicle screws were inserted into T2-L4 vertebrae using CT-based navigation system. The respective overall perforation rates for grade 2 or 3 and grade 3 perforations by surface registration accuracy were 0.2 mm: 0% and 0%; 0.3 mm: 3.5% and 0%; 0.4 mm: 3.5% and 0.8%; 0.5 mm: 8.0% and 3.5%; 0.6 mm: 6.7% and 2.7%; 0.7 mm: 8.9% and 3.8%; 0.8 mm: 9.3% and 6.7%; and 0.9 mm: 9.3% and 4.7%. ROC curve analysis revealed a cut-off surface registration accuracy of 0.5 mm. The major screw perforation rate for a surface registration accuracy of ≥0.5 mm was significantly higher than that for <0.5 mm ( P <0.01). Conclusions: Analysis of screw perforation rate according to surface registration accuracy demonstrated a clinical cut-off of 0.5 mm. Thus, surface registration accuracy should optimally be <0.5 mm for scoliosis surgery with CT-based navigation system.