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CT-Navigated Spinal Instrumentations–Three-Dimensional Evaluation of Screw Placement Accuracy in Relation to a Screw Trajectory Plan
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 t...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9506171/ https://www.ncbi.nlm.nih.gov/pubmed/36143877 http://dx.doi.org/10.3390/medicina58091200 |
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author | Gubian, Arthur Kausch, Lisa Neumann, Jan-Oliver Kiening, Karl Ishak, Basem Maier-Hein, Klaus Unterberg, Andreas Scherer, Moritz |
author_facet | Gubian, Arthur Kausch, Lisa Neumann, Jan-Oliver Kiening, Karl Ishak, Basem Maier-Hein, Klaus Unterberg, Andreas Scherer, Moritz |
author_sort | Gubian, Arthur |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9506171 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-95061712022-09-24 CT-Navigated Spinal Instrumentations–Three-Dimensional Evaluation of Screw Placement Accuracy in Relation to a Screw Trajectory Plan Gubian, Arthur Kausch, Lisa Neumann, Jan-Oliver Kiening, Karl Ishak, Basem Maier-Hein, Klaus Unterberg, Andreas Scherer, Moritz Medicina (Kaunas) Article 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. MDPI 2022-09-01 /pmc/articles/PMC9506171/ /pubmed/36143877 http://dx.doi.org/10.3390/medicina58091200 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Gubian, Arthur Kausch, Lisa Neumann, Jan-Oliver Kiening, Karl Ishak, Basem Maier-Hein, Klaus Unterberg, Andreas Scherer, Moritz CT-Navigated Spinal Instrumentations–Three-Dimensional Evaluation of Screw Placement Accuracy in Relation to a Screw Trajectory Plan |
title | CT-Navigated Spinal Instrumentations–Three-Dimensional Evaluation of Screw Placement Accuracy in Relation to a Screw Trajectory Plan |
title_full | CT-Navigated Spinal Instrumentations–Three-Dimensional Evaluation of Screw Placement Accuracy in Relation to a Screw Trajectory Plan |
title_fullStr | CT-Navigated Spinal Instrumentations–Three-Dimensional Evaluation of Screw Placement Accuracy in Relation to a Screw Trajectory Plan |
title_full_unstemmed | CT-Navigated Spinal Instrumentations–Three-Dimensional Evaluation of Screw Placement Accuracy in Relation to a Screw Trajectory Plan |
title_short | CT-Navigated Spinal Instrumentations–Three-Dimensional Evaluation of Screw Placement Accuracy in Relation to a Screw Trajectory Plan |
title_sort | ct-navigated spinal instrumentations–three-dimensional evaluation of screw placement accuracy in relation to a screw trajectory plan |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9506171/ https://www.ncbi.nlm.nih.gov/pubmed/36143877 http://dx.doi.org/10.3390/medicina58091200 |
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