Use of Intraoperative CT Improves Accuracy of Spinal Navigation During Screw Fixation in Cervico-thoracic Region. Issue 8 (15th April 2021)

• Record Type: Journal Article
• Authors: Habib, Nermine; Filardo, Giuseppe; Distefano, Daniela; Candrian, Christian; Reinert, Michael; Scarone, Pietro
• Is Part Of: Spine. Volume 46:Issue 8(2021)
• Publication Date: 2021-04-15
• Subjects: cervical pedicle screws -- cervical spine -- cervico-thoracic region -- image-guided surgery -- intraoperative 3D imaging -- intraoperative CT -- spinal navigation; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000003827
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: A retrospective analysis of a single-center consecutive series of patients. Objective: To test the hypothesis that using a mobile intraoperative computed tomography in combination with spinal navigation would result in better accuracy of lateral mass and pedicle screws between C3 and T5 levels, compared to cone-beam computed tomography and traditional 2D fluoroscopy. Summary of Background Data: Use of spinal navigation associated with 3D imaging has been shown to improve accuracy of screw positioning in the cervico-thoracic region. However, use of iCT imaging compared to a cone-beam CT has not been fully investigated in these types of surgical interventions. Methods: We retrospectively analyzed a series of patients who underwent posterior cervico-thoracic fixations using different intraoperative imaging systems in a single hospital. We identified three different groups of patients: Group A, operated under 2D-fluoroscopic guidance without navigation; Group B: O-arm guidance with navigation; Group C: iCT AIRO guidance with navigation. Primary outcome was the rate of accurately placed screws, measured on intra or postoperative CT scan with Neo et al . classification for cervical pedicles screws and Gertzbein et al . for thoracic pedicle screws. Screws in cervical lateral masses were evaluated according to a new classification created by the authors. Results: Data on 67 patients and 495 screws were available. Overall screw accuracy was 92.8% (95.6% for lateral mass screws, 81.6% for cervical pedicle screws, and 90% for thoracic pedicle screws). Patients operated with iCT AIRO navigation had significantly fewer misplaced screws (2.4%) compared to 2D-fluoroscopic guidance (9.1%) and O-arm navigation (9.7%) ( P = 0.0152). Accuracy rate of iCT navigation versus O-arm navigation was significantly higher ( P = 0.0042), and there was no statistically significant difference in surgical time between the three Groups ( P = 0.5390). Conclusion: Use of high-quality CT associated with spinal navigation significantly improved accuracy of screw positioning in the cervico-thoracic region. Level of Evidence: 3. Abstract : A common knowledge is that use of 3D intraoperative imaging improves accuracy of screw positioning. This paper tests this hypothesis in a difficult anatomical region, that is the cervico-thoracic region, in a retrospective analysis of 495 screws positioned in 67 patients and compares two different 3D imaging modalities associated with spinal navigation.