Accuracy of portable intraoperative CT with 3D computer navigation versus freehand fluoroscopy-assisted pedicle screw placement in thoracolumbar spine surgery.

Abstract

Accurate placement of pedicle screws is crucial for avoiding complications such as nerve damage or vascular injury. Screws are typically placed freehand using fluoroscopy-guidance. Recently, portable CT combined with 3D navigation (3D-N-iCT) has been developed to guide the placement of pedicle screws. This study compares the accuracy of pedicle screw placement using 3D-N-iCT versus the conventional freehand fluoroscopy guidance for thoracolumbar surgery. The records of patients who underwent thoracolumbar spine surgery with pedicle screw placement from November 2017 to December 2022 at Kaohsiung Chang Gung Memorial Hospital were retrospectively reviewed. Patients were divided into those in which 3D-N-iCT was used and those in whom screws were placed with freehand fluoroscopy guidance (FH-F). Outcomes compared between the 2 groups included screw placement accuracy assessed using the Gertzbein classification, and post-operative complications. A total of 244 patients were included in the study, with 182 in the 3D-N-iCT group and 62 in the FH-F group. The accuracy of screw placement was significantly higher in the 3D-N-iCT group, with 98 % of screws classified as Grade 0 (indicating perfectly positioned) compared to 93 % in the FH-F group (p = 0.010). The placement time was similar between groups (36.0 vs. 33.0 min, p = 0.120). The 3D-N-iCT group had a significantly lower rate of post-operative neurological defects (0 % vs. 5 %, p = 0.016) and complications (0.5 % vs. 8 %, p = 0.004). In conclusions, the use of 3D-N-iCT is associated with greater accuracy in pedicle screw placement during thoracolumbar spine surgeries compared to the freehand technique, without prolonging placement time.