Accuracy of pedicle screw placement by fluoroscopy, a three-dimensional printed model, local electrical conductivity mea
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ORIGINAL ARTICLE
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 Hitoshi Kudo1,2 · Kanichiro Wada1 · Gentaro Kumagai1 · Sunao Tanaka1 · Toru Asari1 · Yasuyuki Ishibashi1 Received: 9 August 2020 / Accepted: 3 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract 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. Keywords Scoliosis · Accuracy · Pedicle screw · Three-dimensional printed model · Local electrical conductivity measurement device · Intraoperative computed tomography navigation
Introduction The primary goals of scoliosis surgery are to halt curve progression and to maintain an ideal three-dimensional (3D) trunk balance. Posterior spinal instrumentation and fusion is the current standard surgery for the treatment of progressive idiopathic, congenital, or syndromic scoliosis. Pedicle * Hitoshi Kudo [email protected] 1
Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu‑cho, Hirosaki 036‑8562, Japan
Department of Orthopaedic Surgery, Mutsu General Hospital, 1‑2‑8 Kogawa‑machi, Mutsu 035‑8601, Japan
2
screws (PS) have been widely used for scoliosis correction surgery in past 2 decades [1, 2]. However, complications, such as neurological deficits, vascular injury, and pneumothorax, have been reported after misplacement
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