Spinal Navigation for Cervical Pedicle Screws: Surgical Pearls and Pitfalls

• Published in: Global spine journal Vol. 11; no. 2; pp. 196 - 202
• Main Authors: Gan, Gerrard, Kaliya-Perumal, Arun-Kumar, Yu, Chun Sing, Nolan, Colum Patrick, Oh, Jacob Yoong-Leong
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.03.2021; Sage Publications Ltd
• Subjects: Back surgery; CAS; Computer assisted surgery; Original; Surgical outcomes; Surgical techniques; intraoperative complications; pedicle screws; equipment safety; neuronavigation; computer-assisted surgery
• ISSN: 2192-5682; 2192-5690
• DOI: 10.1177/2192568220902093

Study Design: Retrospective cohort study. Objective: We intend to evaluate the accuracy and safety of cervical pedicle screw (CPS) insertion under O-arm-based 3-dimensional (3D) navigation guidance. Methods: This is a retrospective study of patients who underwent CPS insertion under intraoperative O-arm-based 3D navigation during the years 2009 to 2018. The radiological accuracy of CPS placement was evaluated using their intraoperative scans. Results: A total of 297 CPSs were inserted under navigation. According to Gertzbein classification, 229 screws (77.1%) were placed without any pedicle breach (grade 0). Of the screws that did breach the pedicle, 51 screws (17.2%) had a minor breach of less than 2 mm (grade 1), 13 screws (4.4%) had a breach of between 2 and 4 mm (grade 2), and 4 screws (1.3%) had a complete breach of 4 mm or more (grade 3). Six screws were revised intraoperatively. There was no incidence of neurovascular injury in this series of patients. 59 of the 68 breaches (86.8%) were found to perforate laterally, and the remaining 9 (13.2%) medially. It was noted that the C5 cervical level had the highest breach rate of 33.3%. Conclusions: O-arm-based 3D navigation can improve the accuracy and safety of CPS insertion. The overall breach rate in this study was 22.9%. Despite these breaches, there was no incidence of neurovascular injury or need for revision surgery for screw malposition.