Computer-assisted spine surgery.

Abstract

The aim of this study was to improve the reliability of pedicle screw insertion. Transpedicle screw insertion may cause neurological, vascular, and mechanical complications. Previous studies of surgical procedures have shown a significant rate of incorrect placement of the screw ranging from 10 to 40%. A new technique that combines preoperative computed tomography (CT) imaging with intraoperative passive navigation was used to perform 64 pedicle screw insertions in the thoracolumbar region. At the same time, 64 pedicle screw insertions were performed manually in the same region and on the same vertebral levels. Surgery was followed in all cases by postoperative radiographs and computed tomography examination, which allowed measurements of screw position relative to pedicle position to be performed. A comparison between the two groups showed that six screws in 64 vertebra (9%) had incorrect placement with the computer-assisted technique whereas 28 screws in 64 vertebra (44%) had incorrect placement with manual insertion. The intraoperative accuracy provided by the computer after registration was better than 1 mm. The good results obtained are similar to those reported in the literature. The cortex penetration observed with the computer-assisted technique was not imputed to computer failure. Errors by the surgeon in acquiring data in the pre- and perioperative steps may explain the six incorrect screw placements. This clinical experience confirms that the accuracy and the reliability of this computer-assisted technique are good.