APPLICATION OF INTRAOPERATIVE CT NAVIGATION IN POSTERIOR THORACIC PEDICLE SCREW PLACEMENT FOR SCOLIOSIS PATIENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHI Xinge , ZHANG Yonggang , ZHANG Xuesong , CUI Geng , MAO Keya , WANG Zheng , DONG Tianxiang , WANG Yan.

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China. Corresponding author: ZHANG Yonggang, E-mail: zhangyg@hotmail.com;

Corresponding author：

Keywords：

Scoliosis; Posterior thoracic pedicle screw placement Intraoperative; CT navigation

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Objective To investigate the application value of intraoperative CT navigation in posterior thoracic pedicle screw placement for scoliosis patients. Methods Between October 2009 and December 2011, 46 patients with scoliosis were treated with thoracic pedicle screw placement under intraoperative CT navigation in 21 cases (group A) or under C-arm fluoroscopy in 25 cases (group B). There was no significant difference in age, gender, type of scoliosis, involved segment, and Cobb angle of main thoracic curve between 2 groups (P gt; 0.05). A total of 273 thoracic pedicle screws were placed in group A and 308 screws in group B. The pedicle screw position evaluated and classified by intraoperative CT images according to the Modi et al. method; and the accurate rate, the safe rate, and the potential risk rate of pedicle screws were calculated on the upper thoracic spine (T1-4), the middle thoracic spine (T5-8), the lower thoracic spine (T9-12), and the entire thoracic spine (T1-12). The accuracy and security of thoracic pedicle screw placement were compared between 2 groups. Results On the entire thoracic spine, the accurate rate of group A (93.4%) was significantly higher than that of group B (83.8%), the safe rate of group A (98.9%) was significantly higher than that of group B (92.5%), showing significant differences between 2 groups (P lt; 0.05). However, the potential risk rate of group B (7.5%) was significantly higher than that of group A (1.1%) (P lt; 0.05). On the upper, the middle, and the lower thoracic spines, there was no significant difference in the accurate rate, the safe rate, and the potential risk rate of pedicle screws between 2 groups (P gt; 0.05). According to CT evaluation results, the potential risk pedicle screws were revised or removed during operation. The patients of 2 groups had no neurological deficits through physical examination of nervous system at 3 days after operation. Conclusion Intraoperative CT navigation can improve the accuracy and security of posterior thoracic pedicle screw placement and it can ensure the safety of operation by finding and promptly removing or revising the potential risk pedicle screws.

Citation： SHI Xinge,ZHANG Yonggang,ZHANG Xuesong,CUI Geng,MAO Keya,WANG Zheng,DONG Tianxiang,WANG Yan.. APPLICATION OF INTRAOPERATIVE CT NAVIGATION IN POSTERIOR THORACIC PEDICLE SCREW PLACEMENT FOR SCOLIOSIS PATIENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(12): 1415-1419. doi: Copy

1.	15 Barzilay Y, Liebergall M, Fridlander A, et al. Miniature robotic guidance for spine surgery — introduction of a novel system and analysis of challenges encountered during the clinical development phase at two spine centres. Int J Med Robot, 2006, 2(2): 146-153.
2.	18 Rajasekaran S, Vidyadhara S, Ramesh P, et al. Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976), 2007, 32(2): E56-64. 19 V Rajan V, Kamath V, Shetty AP, et al. Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine. Indian J Orthop, 2010, 44(2): 163-168.
3.	24 Zausinger S, Scheder B, Uhl E, et al. Intraoperative computed tomography with integrated navigation system in spinal stabilizations. Spine (Phila Pa 1976), 2009, 34(26): 2919-2926. 25 Cui G, Wang Y, Kao TH, et al. Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine (Phila Pa 1976), 2012, 37(10): 891-900.
4.
5.
6.	Yu CH, Chen PQ, Ma SC, et al. Segmental correction of adolescent idiopathic scoliosis by all-screw fixation method in adolescents and young adults. minimum 5 years follow-up with SF-36 questionnaire. Scoliosis, 2012, 7: 5.
7.	Sucato DJ. Management of severe spinal deformity: scoliosis and kyphosis. Spine (Phila Pa 1976), 2010, 35(25): 2186-2192.
8.	Yu B, Zhang JG, Qiu GX, et al. Posterior selective thoracic fusion in adolescent idiopathic scoliosis patients: a comparison of all pedicle screws versus hybrid instrumentation. Chin Med Sci J, 2009, 24(1): 30-35.
9.	Carreon LY, Puno RM, Lenke LG, et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg (Am), 2007, 89(11): 2427-2432.
10.	Di Silvestre M, Parisini P, Lolli F, et al. Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976), 2007, 32(15): 1655-1661.
11.	Hicks JM, Singla A, Shen FH, et al. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976), 2010, 35(11): E465-470.
12.	Wang W, Zhu Z, Zhu F, et al. The changes of relative position of the thoracic aorta after anterior or posterior instrumentation of type I Lenke curve in adolescent idiopathic thoracic scoliosis. Eur Spine J, 2008, 17(8): 1019-1026.
13.	Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
14.	Cinotti G, Gumina S, Ripani M, et al. Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws. Spine (Phila Pa 1976), 1999, 24(2): 114-119.
15.	Nakanishi K, Tanaka M, Misawa H, et al. Usefulness of a navigation system in surgery for scoliosis: segmental pedicle screw fixation in the treatment. Arch Orthop Trauma Surg, 2009, 129(9): 1211-1218.
16.	Modi H, Suh SW, Song HR, et al. Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique. International Orthopaedics, 2008, 33(2): 469-475.
17.	Modi HN, Suh SW, Femandez H, et al. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J, 2008, 17(12): 1686-1696.
18.	Kim YJ, Lenke LG, Cheh G, et al. Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: a comparison with computerized tomography. Spine (Phila Pa 1976), 2005, 30(18): 2084-2088.
19.	Samdani AF, Ranade A, Saldanha V, et al. Learning curve for placement of thoracic pedicle screws in the deformed spine. Neurosurgery, 2010, 66(2): 290-295.
20.	Kantelhardt SR, Bock CH, Larsen J, et al. Intraosseous ultrasound in the placement of pedicle screws in the lumbar spine. Spine (Phila Pa 1976), 2009, 34(4): 400-407.
21.	Nottmeier EW, Seemer W, Young PM. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine, 2009, 10(1): 33-39.
22.	Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J, 2012, 21(2): 247-255.
23.	Takahashi S, Morikawa S, Saruhashi Y, et al. Percutaneous transthoracic fenestration of an intramedullary neurenteric cyst in the thoracic spine with intraoperative magnetic resonance image navigation and thoracoscopy. J Neurosurg Spine, 2008, 9(5): 488-492.
24.	Larson AN, Santos ER, Polly DW, et al. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Spine (Phila Pa 1976), 2012, 37(3): E188-194.
25.	Takeshita K, Maruyama T, Chikuda H, et al. Diameter, length, and direction of pedicle screws for scoliotic spine. Spine (Phila Pa 1976), 2009, 34(8): 798-803.
26.	Metz LN, Burch S. Computer-assisted surgical planning and image-guided surgical navigation in refractory adult scoliosis surgery: case report and review of the literature. Spine (Phila Pa 1976), 2008, 33(9): E287-292.

1. 15 Barzilay Y, Liebergall M, Fridlander A, et al. Miniature robotic guidance for spine surgery — introduction of a novel system and analysis of challenges encountered during the clinical development phase at two spine centres. Int J Med Robot, 2006, 2(2): 146-153.
2. 18 Rajasekaran S, Vidyadhara S, Ramesh P, et al. Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976), 2007, 32(2): E56-64. 19 V Rajan V, Kamath V, Shetty AP, et al. Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine. Indian J Orthop, 2010, 44(2): 163-168.
3. 24 Zausinger S, Scheder B, Uhl E, et al. Intraoperative computed tomography with integrated navigation system in spinal stabilizations. Spine (Phila Pa 1976), 2009, 34(26): 2919-2926. 25 Cui G, Wang Y, Kao TH, et al. Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine (Phila Pa 1976), 2012, 37(10): 891-900.
4.
5.
6. Yu CH, Chen PQ, Ma SC, et al. Segmental correction of adolescent idiopathic scoliosis by all-screw fixation method in adolescents and young adults. minimum 5 years follow-up with SF-36 questionnaire. Scoliosis, 2012, 7: 5.
7. Sucato DJ. Management of severe spinal deformity: scoliosis and kyphosis. Spine (Phila Pa 1976), 2010, 35(25): 2186-2192.
8. Yu B, Zhang JG, Qiu GX, et al. Posterior selective thoracic fusion in adolescent idiopathic scoliosis patients: a comparison of all pedicle screws versus hybrid instrumentation. Chin Med Sci J, 2009, 24(1): 30-35.
9. Carreon LY, Puno RM, Lenke LG, et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg (Am), 2007, 89(11): 2427-2432.
10. Di Silvestre M, Parisini P, Lolli F, et al. Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976), 2007, 32(15): 1655-1661.
11. Hicks JM, Singla A, Shen FH, et al. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976), 2010, 35(11): E465-470.
12. Wang W, Zhu Z, Zhu F, et al. The changes of relative position of the thoracic aorta after anterior or posterior instrumentation of type I Lenke curve in adolescent idiopathic thoracic scoliosis. Eur Spine J, 2008, 17(8): 1019-1026.
13. Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
14. Cinotti G, Gumina S, Ripani M, et al. Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws. Spine (Phila Pa 1976), 1999, 24(2): 114-119.
15. Nakanishi K, Tanaka M, Misawa H, et al. Usefulness of a navigation system in surgery for scoliosis: segmental pedicle screw fixation in the treatment. Arch Orthop Trauma Surg, 2009, 129(9): 1211-1218.
16. Modi H, Suh SW, Song HR, et al. Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique. International Orthopaedics, 2008, 33(2): 469-475.
17. Modi HN, Suh SW, Femandez H, et al. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J, 2008, 17(12): 1686-1696.
18. Kim YJ, Lenke LG, Cheh G, et al. Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: a comparison with computerized tomography. Spine (Phila Pa 1976), 2005, 30(18): 2084-2088.
19. Samdani AF, Ranade A, Saldanha V, et al. Learning curve for placement of thoracic pedicle screws in the deformed spine. Neurosurgery, 2010, 66(2): 290-295.
20. Kantelhardt SR, Bock CH, Larsen J, et al. Intraosseous ultrasound in the placement of pedicle screws in the lumbar spine. Spine (Phila Pa 1976), 2009, 34(4): 400-407.
21. Nottmeier EW, Seemer W, Young PM. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine, 2009, 10(1): 33-39.
22. Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J, 2012, 21(2): 247-255.
23. Takahashi S, Morikawa S, Saruhashi Y, et al. Percutaneous transthoracic fenestration of an intramedullary neurenteric cyst in the thoracic spine with intraoperative magnetic resonance image navigation and thoracoscopy. J Neurosurg Spine, 2008, 9(5): 488-492.
24. Larson AN, Santos ER, Polly DW, et al. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Spine (Phila Pa 1976), 2012, 37(3): E188-194.
25. Takeshita K, Maruyama T, Chikuda H, et al. Diameter, length, and direction of pedicle screws for scoliotic spine. Spine (Phila Pa 1976), 2009, 34(8): 798-803.
26. Metz LN, Burch S. Computer-assisted surgical planning and image-guided surgical navigation in refractory adult scoliosis surgery: case report and review of the literature. Spine (Phila Pa 1976), 2008, 33(9): E287-292.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF INTRAOPERATIVE CT NAVIGATION IN POSTERIOR THORACIC PEDICLE SCREW PLACEMENT FOR SCOLIOSIS PATIENTS

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