J Korean Neurosurg Soc.  2020 Nov;63(6):777-783. 10.3340/jkns.2020.0001.

Accuracy of Freehand versus Navigated Thoracolumbar Pedicle Screw Placement in Patients with Metastatic Tumors of the Spine

• Ramos RDLG
• Echt M
• Benton JA
• Gelfand Y
• Longo M
• Yanamadala V
• Yassari R

• KMID: 2508608
• DOI: http://doi.org/10.3340/jkns.2020.0001

Abstract

Objective
: To compare the accuracy and breach rates of freehand (FH) versus navigated (NV) pedicle screws in the thoracic and lumbar spine in patients with metastatic spinal tumors.
Methods
: A retrospective review of adult patients who underwent pedicle screw fixation in the thoracic or lumbar spine for metastatic spinal tumors between 2012 and 2018 was conducted. Breaches were assessed based on the Gertzbein and Robbins classification and only screws placed >4 mm outside of the pedicle wall (lateral or medial) were considered breached.
Results
: A total of 62 patients received 547 pedicle screws (average 8 per patient) – 34 patients received 298 pedicle screws in the FH group and 28 patients received 249 screws in the NV group. There were 40/547 breaches, corresponding to a breach and accuracy rate of 7.3% and 92.7%, respectively. The breach rate was 9.7% in the FH group and 4.4% in the NV group (chi-squared test, p=0.017); this corresponded to an accuracy rate of 90.3% and 95.6%, respectively. Only one patient from the overall cohort (in the FH group) required revision surgery due to a medial breach abutting the spinal cord (1.6% of all patients; 2.9% of FH patients); no patient suffered organ, vessel, or neurological injury from screw breaches.
Conclusion
: Navigated pedicle screw placement in patients with metastatic spinal tumors has a significantly higher radiographic accuracy compared to the FH technique. However, the revision surgery was low and no patient suffered from clinically-relevant breach. Navigation also offers the advantage of real-time localization of spinal tumors and aids in targeting and resection of these lesions.

Keyword

Spinal fusion; Instrumentation; Pedicle screws; Spinal neoplasms

Figure

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  Fig. 1. Distribution of 547 pedicle screws placed in 62 patients with metastatic tumors of the spine. The distribution of screw placement by the freehand (blue) and navigated (red) technique was not significantly different (all p>0.05).

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  Fig. 2. Distribution of 47 pedicle screws breaches in 62 patients with metastatic tumors of the spine. The distribution of screw placement by the freehand (blue) and navigated (red) technique was not significantly different (all p>0.05).

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  Fig. 3. Postoperative computed tomography scans showing examples of a lateral breach (left) and a medial breach (right). The patient with the medial breach was the only patient in our study who underwent revision due to close proximity to the spinal cord; no neurological sequelae occurred. This patient also had some extravasation of cement into the adjacent vasculature without any sequelae.

Reference

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