Routine spinal navigation for thoraco–lumbar pedicle screw insertion using the O-arm three-dimensional imaging system improves placement accuracy

• Published in: Journal of clinical neuroscience 2014-03, Vol.21 (3), p.493-498
• Main Authors: Ling, Ji Min, Dinesh, Shree Kumar, Pang, Boon Chuan, Chen, Min Wei, Lim, Heng Lip, Louange, Danny T, Yu, Chun Sing, Wang, Chee Meng Ernest
• Format: Article
• Language: English
• Subjects: Bone Screws; Female; Humans; Imaging, Three-Dimensional - methods; Male; Middle Aged; Navigation; Neurology; Neuronavigation - methods; O-arm; Pedicle screw; Retrospective Studies; Spinal Diseases - surgery; Spinal Fusion - methods; Stereotaxy
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2013.02.034

Abstract Modern image-guided spinal navigation employs high-quality intra-operative three dimensional (3D) images to improve the accuracy of spinal surgery. This study aimed to assess the accuracy of thoraco-lumbar pedicle screw insertion using the O-arm (Breakaway Imaging, LLC, Littleton, MA, USA) 3D imaging system. Ninety-two patients underwent insertion of thoraco–lumbar pedicle screws guided by O-arm navigation over a 27 month period. Intra-operative scans were retrospectively reviewed for pedicle breach. The operative time of patients where O-arm navigation was used was compared to a matched control group where fluoroscopy was used. A total of 467 pedicle screws were inserted. Four hundred and forty-five screws (95.3%) were placed within the pedicle without any breach (Gertzbein classification grade 0). Sixteen screws (3.4%) had a pedicle breach of less than 2 mm (Gertzbein classification grade 1), and six screws (1.3%) had a pedicle breach between 2 mm and 4 mm (Gertzbein classification grade 2). The grade 2 screws were revised intra-operatively. There was no incidence of neurovascular injury in this series of patients. The mean operative time for O-arm patients was 5.25 hours. In a matched control group of fluoroscopy patients, the mean operative time was 4.75 hours. The difference in the mean operative time between the two groups was not statistically significant ( p = 0.15, paired t -test). Stereotactic navigation based on intra-operative O-arm 3D imaging resulted in high accuracy in thoraco–lumbar pedicle screw insertion.