CT-navigated spinal instrumentations-three-dimensional evaluation of screw placement accuracy in relation to a screw trajectory pan

• Verfasst von: Gubian, Arthur [VerfasserIn]
• Verfasst von: Kausch, Lisa [VerfasserIn]
• Verfasst von: Neumann, Jan-Oliver [VerfasserIn]
• Verfasst von: Kiening, Karl [VerfasserIn]
• Verfasst von: Ishak, Basem [VerfasserIn]
• Verfasst von: Maier-Hein, Klaus H. [VerfasserIn]
• Verfasst von: Unterberg, Andreas [VerfasserIn]
• Verfasst von: Scherer, Moritz [VerfasserIn]
• Titel: CT-navigated spinal instrumentations-three-dimensional evaluation of screw placement accuracy in relation to a screw trajectory pan
• Verf.angabe: Arthur Gubian, Lisa Kausch, Jan-Oliver Neumann, Karl Kiening, Basem Ishak, Klaus Maier-Hein, Andreas Unterberg and Moritz Scherer
• E-Jahr: 2022
• Jahr: 1 September 2022
• Umfang: 17 S.
• Fussnoten: Gesehen am 20.10.2022
• Titel Quelle: Enthalten in: Medicina
• Ort Quelle: Kaunas : Kaunas Univ. of Medicine, 2001
• Jahr Quelle: 2022
• Band/Heft Quelle: 58(2022), 9, Artikel-ID 1200, Seite 1-17
• ISSN Quelle: 1648-9144
• DOI: doi:10.3390/medicina58091200
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Gertzbein-Robbins classification
• Sach-SW: navigation-guided spine surgery
• Sach-SW: pedicle screw accuracy
• Sach-SW: spinal instrumentation
• Sach-SW: spinal navigation
• Sach-SW: three-dimensional accuracy
• K10plus-PPN: 1819458989

Abstract

Background and Objectives: In the literature, spinal navigation and robot-assisted surgery improved screw placement accuracy, but the majority of studies only qualitatively report on screw positioning within the vertebra. We sought to evaluate screw placement accuracy in relation to a preoperative trajectory plan by three-dimensional quantification to elucidate technical benefits of navigation for lumbar pedicle screws. Materials and Methods: In 27 CT-navigated instrumentations for degenerative disease, a dedicated intraoperative 3D-trajectory plan was created for all screws. Final screw positions were defined on postoperative CT. Trajectory plans and final screw positions were co-registered and quantitatively compared computing minimal absolute differences (MAD) of screw head and tip points (mm) and screw axis (degree) in 3D-space, respectively. Differences were evaluated with consideration of the navigation target registration error. Clinical acceptability of screws was evaluated using the Gertzbein-Robbins (GR) classification. Results: Data included 140 screws covering levels L1-S1. While screw placement was clinically acceptable in all cases (GR grade A and B in 112 (80%) and 28 (20%) cases, respectively), implanted screws showed considerable deviation compared to the trajectory plan: Mean axis deviation was 6.3° ± 3.6°, screw head and tip points showed mean MAD of 5.2 ± 2.4 mm and 5.5 ± 2.7 mm, respectively. Deviations significantly exceeded the mean navigation registration error of 0.87 ± 0.22 mm (p < 0.001). Conclusions: Screw placement was clinically acceptable in all screws after navigated placement but nevertheless, considerable deviation in implanted screws was noted compared to the initial trajectory plan. Our data provides a 3D-quantitative benchmark for screw accuracy achievable by CT-navigation in routine spine surgery and suggests a framework for objective comparison of screw outcome after navigated or robot-assisted procedures. Factors contributing to screw deviations should be considered to assure optimal surgical results when applying navigation for spinal instrumentation.