Accuracy of pedicle screw placement by fluoroscopy, a three-dimensional printed model, local electrical conductivity measurement device, and intraoperative computed tomography navigation in scoliosis patients

• Published in: European journal of orthopaedic surgery & traumatology 2021-04, Vol.31 (3), p.563-569
• Main Authors: Kudo, Hitoshi, Wada, Kanichiro, Kumagai, Gentaro, Tanaka, Sunao, Asari, Toru, Ishibashi, Yasuyuki
• Format: Article
• Language: English
• Subjects: Accuracy; Medicine; Medicine & Public Health; Original Article; Patients; Scoliosis; Statistical analysis; Surgery; Surgical Orthopedics; Traumatic Surgery; Vertebrae; X-rays
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-020-02803-2

Introduction There are several assisted methods for the accurate placement of pedicle screw (PS), including fluoroscopy, a three-dimensional (3D) printed model, a local electrical conductivity measurement device (LECMD), and intraoperative computed tomography (CT) navigation. Objectives This study aimed to investigate the accuracy of PS placement and clinical results using different assisted methods. Methods This study included 553 pedicle screws in 31 patients. We divided patients into the fluoroscopy (F) group ( n  = 79), 3D printed model and fluoroscopy (3D + F) group ( n  = 150), LECMD, 3D printed model, and fluoroscopy (LECMD + 3D + F) group ( n  = 171), and the intraoperative CT navigation ( N ) group ( n  = 153). We evaluated the operative time, intraoperative bleeding, number of fusion vertebrae, correction rate of the main curve, apical vertebral translation, grade of PS perforation (Grade 0: no perforation; Grade 1:  4 mm), and accuracy of PS placement. Results The N group had a significantly longer operative time. There were no significant differences in the clinical results excluding the operative time. The accuracy of PS placement was 93.7%, 91.3%, 93.6%, and 93.5% in the F, 3D + F, LECMD + 3D + F, and N groups, respectively. The Grade 2 perforation rate was 2.5%, 0%, 0.6%, and 0.7% in the F, 3D + F, LECMD + 3D + F, and N groups, respectively. Conclusions There were no significant differences in the accuracy of PS placement and clinical results excluding the operative time. The 3D printed model, LECMD, or intraoperative CT navigation would be useful to prevent Grade 2 perforation.