Implications of navigation in thoracolumbar pedicle screw placement on screw accuracy and screw diameter/pedicle width ratio

• Published in: Brain & spine 2023, Vol.3, p.101780-101780, Article 101780
• Main Authors: Mandelka, Eric, Gierse, Jula, Zimmermann, Felix, Gruetzner, Paul A., Franke, Jochen, Vetter, Sven Y.
• Format: Article
• Language: English
• Subjects: C-Arm navigation; Image-guided surgery; Intraoperative imaging; Screw accuracy; Screw size; Spinal navigation
• ISSN: 2772-5294; 2772-5294
• DOI: 10.1016/j.bas.2023.101780

There is ample evidence that higher accuracy can be achieved in thoracolumbar pedicle screw placement by using spinal navigation. Still, to date, the evidence regarding the influence of the use of navigation on the screw diameter to pedicle width ratio remains limited. The aim of this study was to investigate the implications of navigation in thoracolumbar pedicle screw placement not only on screw accuracy, but on the screw diameter to pedicle width ratio as well. In this single-center single-surgeon study, 45 Patients undergoing navigated thoracolumbar pedicle screw placement were prospectively included. The results were compared with a matched comparison group of patients in which screw placement was performed under fluoroscopic guidance. The screw accuracy and the screw diameter to pedicle width ratio of every screw were compared between the groups. Screw accuracy was significantly higher in the navigation group compared to the fluoroscopic guidance group, alongside with a significant increase of the screw diameter to pedicle width ratio by approximately 10%. In addition, both the intraoperative radiation dose and the operating time tended to be lower in the study group. This study was able to show that navigated thoracolumbar pedicle screw placement not only increases the accuracy of screw placement but also facilitates the selection of the adequate screw sizes, which according to the literature has positive effects on fixation strength. Meanwhile, the use of navigation did not negatively affect the time needed for surgery or the patient's intraoperative exposure to radiation. •Matched comparison of navigated and fluoroscopy-guided pedicle screw placement.•Accuracy was significantly higher with navigation compared to fluoroscopic guidance.•In both groups, none of the breaches resulted in postoperative morbidities.•Screw diameter to pedicle width ratio was significantly higher using navigation.•No significant differences found for operating time and patient radiation dose.