Cervical Pedicle Screws: Conventional Versus Computer-Assisted Placement of Cannulated Screws

作者：Marcus Richter, Balkan Cakir, R. Schmidt · 发表于：Spine · 年份：2005 · DOI：10.1097/01.brs.0000182275.31425.cd · 被引用次数：226 · 研究领域：Spinal Fractures and Fixation Techniques、Cervical and Thoracic Myelopathy、Intraoperative Neuromonitoring and Anesthetic Effects

STUDY DESIGN: Prospective clinical study with postoperative radiologic control of pedicle screw placement in the cervical spine. OBJECTIVES: To evaluate whether cervical pedicle screws can be placed safely in a conventional technique when using cannulated screws and separate stab incisions. Also, to evaluate if accuracy and safety of pedicle screw placement can be improved using a computer-assisted surgery (CAS) system (VectorVision; BrainLAB AG, Heimstetten, Germany). SUMMARY OF BACKGROUND DATA: Pedicle screws are rarely used in the cervical spine compared to the use in lumbar and thoracic spine. The main reason is probably the potential risk of iatrogenic damage to the spinal cord, nerve roots, or vertebral artery caused by screw misplacement as well as the more demanding technique of pedicle screw placement in the cervical spine. METHODS: A total of 52 consecutive patients with posterior cervical or cervicothoracic instrumentations using pedicle screws were evaluated prospectively. For the first 20 patients, 93 pedicle screws were implanted using the conventional technique with the image intensifier in the lateral view, and for the next 32 patients (167 screws), a CAS system was additionally used. For registration of the vertebra, surface-matching algorithms were used. For evaluation of screw placement, postoperative computerized tomography with multiplanar reconstructions in the screw axis was performed for each screw. RESULTS: No implant-related complications were observ...