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  • Comparison of cross-sectional lumbar pedicle fill when placing screws with navigation versus free hand technique

    Final Number:
    1196

    Authors:
    Stephen M. Pirris MD; Eric W. Nottmeier MD; Gazanfar Rahmathulla; Michael C. O'Brien; Mark A. Pichelmann MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Pedicle screw instrumentation has been shown to be a useful adjunct in obtaining spinal fixation in arthrodesis surgery. Spinal navigation has been shown to improve the accuracy of pedicle screw placement. Increasing the percent of pedicle that is filled with the screw presumably yields greater fixation. It has not been shown whether or not spinal navigation helps surgeons more completely fill their instrumented pedicles.

    Methods: 50 consecutive patients from each arm (navigated and free-hand) were retrospectively reviewed. Cross-sectional area of each instrumented lumbar pedicle and screw were measured utilizing an automatic area calculation tool on the Mayo QReads radiologic imaging system. The coronal images and measurements were blinded for review by the surgeons to confirm accuracy of the measurements.

    Results: The instrumented pedicles in the navigated patients were significantly more filled in the coronal plane by screws than the pedicles in the non-navigated patients. The size of the pedicles in each group were not significantly different. (p=0.4903) However, the screw diameters in the navigated patients were statistically significantly larger than those in the free hand patients. (p=0.00000334) This finding then calculated to a statistically significant increased cross-sectional pedicle fill for patients in the image guidance group. (p=0.00000427)

    Conclusions: Obtaining a higher cross-sectional percentage fill of the pedicle with a screw is expected to provide greater spinal fixation in instrumented fusion surgery. This study helps to confirm that utilizing spinal navigation helps to more completely fill the pedicles that are being instrumented.

    Patient Care: Provide further data for the benefits of utilizing navigation in complex spine surgery

    Learning Objectives: The attendees will learn the rationale for measuring the percent fill of a pedicle by screws. The attendees will learn that spinal navigation allows for increased pedicle fill by screws

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