Although the learning curve for intraoperative 3-D fluoroscopy-navigated pedicle screw placement is high, the approach can help improve accuracy and reduce patients’ and surgeons’ exposure to radiation once the curve is overcome, according to findings from a recently published study.
The prospective study included a 145 patients undergoing dorsal navigated instrumentation for placement of 928 pedicle screws (PS) between January 2011 and June 2012. The duration of intraoperative 3-D scans, PS placement, PS-related revision and complications, and the accuracy of PS placement on postoperative CT scans were the main outcomes measures for the study.
A total of 736 lumbosacral and 192 thoracic screws were placed in the patients. The time spans were divided into four periods, and results from the first period were compared with the second, third and fourth periods.
In the first and fourth periods, the mean scan time decreased from 15.4 minutes to 8.4 minutes (P < .001), according to the researchers. Additionally, the mean PS insertion time decreased from 5.3 minutes to 3.2 minutes (P < .001), and the mean control time after PS placement decreased from 11.2 minutes to 6.6 minutes (P < .001).
Accuracy of PS placement improved from the first to third periods, but decreased from the third to fourth, from 96.4% (third period, P = .002) to 92.4% (fourth period, P = .049).
According to data in the study, 3-D fluoroscopy-navigated PS placement with regard to intraoperative 3D scan acquisition, PS placement time and PS accuracy had significant learning curves. One revision was reported, and no learning effect was observed in relation to intraoperative screw revisions, according to the researchers. – by Robert Linnehan
Disclosures: Ryang has received support for speaking and/or teaching engagements and travel from BrainLAB. Please see the full study for a list of all other authors’ relevant financial disclosures.