Universität zu Köln

Bredow, J., Oppermann, J., Kraus, B., Schiller, P., Schiffer, G., Sobottke, R., Eysel, P. and Koy, T. (2015). The accuracy of 3D fluoroscopy-navigated screw insertion in the upper and subaxial cervical spine. Eur. Spine J., 24 (12). S. 2967 - 2977. NEW YORK: SPRINGER. ISSN 1432-0932

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Abstract

Due to better primary stability and repositioning options, pedicle screws are increasingly used during posterior stabilization of the cervical spine. However, the serious risks generally associated with the insertion of screws in the cervical spine remain. The purpose of this study is to examine the accuracy of pedicle screw insertion with the use of 3D fluoroscopy navigation systems, also accounting for various spine levels. Data of 64 patients were collected during and after screw implantation (axial and subaxial) in the cervical spine. 207 screws were implanted from C1 to C7 and analyzed for placement accuracy according to postoperative CT scans and following the modified Gertzbein and Robbins classification. The accuracy of most of the inserted screws was assessed as grade 2 according to the modified Gertzbein and Robbins classification. 93.9 % of the screws implanted at C1 or C2, and 78.51 % of the screws implanted at levels C3-C7 showed placement accuracy grade 2 or better, indicating pedicle wall perforation of < 2 mm. Overall, seven complications were observed. In three cases, the vertebral artery was affected, leading to one fatality. Surgical revision was necessary once because of Magerl screw misplacement and three times due to impaired wound healing. No radicular symptoms resulted from screw malposition. Axial and subaxial screws can be inserted with a high grade of accuracy using 3D fluoroscopy-based navigation systems. Nevertheless, while this useful innovation helps to minimize the risks of misplacement, the surgery is still a challenge, as arising complications remain severe.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bredow, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Oppermann, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kraus, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schiller, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schiffer, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sobottke, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Eysel, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Koy, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-385321
DOI:	10.1007/s00586-015-3974-2
Journal or Publication Title:	Eur. Spine J.
Volume:	24
Number:	12
Page Range:	S. 2967 - 2977
Date:	2015
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-0932
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PEDICLE SCREW; COMPUTED-TOMOGRAPHY; NONTRAUMATIC LESIONS; CLINICAL ACCURACY; FREE-HAND; FIXATION; PLACEMENT; COMPLICATIONS; STABILITY; LANDMARKS Multiple languages Clinical Neurology; Orthopedics Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/38532