Minimally invasive percutaneous transpedicular screw fixation: Increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system

Ron Von Jako, Michael A. Finn, Kenneth S. Yonemura, Ali Araghi, Larry T. Khoo, John A. Carrino, Mick Perez-Cruet

Research output: Contribution to journalArticle

Abstract

Background: Minimally invasive percutaneous pedicle screw instrumentation methods may increase the need for intraoperative fluoroscopy, resulting in excessive radiation exposure for the patient, surgeon, and support staff. Electromagnetic field (EMF)-based navigation may aid more accurate placement of percutaneous pedicle screws while reducing fluoroscopic exposure. We compared the accuracy, time of insertion, and radiation exposure of EMF with traditional fluoroscopic percutaneous pedicle screw placement. Methods: Minimally invasive pedicle screw placement in T8 to S1 pedicles of eight fresh-frozen human cadaveric torsos was guided with EMF or standard fluoroscopy. Set-up, insertion, and fluoroscopic times and radiation exposure and accuracy (measured with post-procedural computed tomography) were analyzed in each group. Results: Sixty-two pedicle screws were placed under fluoroscopic guidance and 60 under EMF guidance. Ideal trajectories were achieved more frequently with EMF over all segments (62.7% vs. 40%; p=0.01). Greatest EMF accuracy was achieved in the lumbar spine, with significant improvements in both ideal trajectory and reduction of pedicle breaches over fluoroscopically guided placement (64.9% vs. 40%, p=0.03, and 16.2% vs. 42.5%, p=0.01, respectively). Fluoroscopy time was reduced 77% with the use of EMF (22 s vs. 5 s per level; p<0.0001) over all spinal segments. Radiation exposure at the hand and body was reduced 60% (p=0.058) and 32% (p=0.073), respectively. Time for insertion did not vary between the two techniques. Conclusions: Minimally invasive pedicle screw placement with the aid of EMF image guidance reduces fluoroscopy time and increases placement accuracy when compared with traditional fluoroscopic guidance while adding no additional time to the procedure.

Original languageEnglish (US)
Pages (from-to)589-596
Number of pages8
JournalActa Neurochirurgica
Volume153
Issue number3
DOIs
StatePublished - Mar 1 2011

Keywords

  • Accuracy
  • Electromagnetic field navigation
  • Fluoroscopy
  • Minimally invasive
  • Pedicle screw

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Minimally invasive percutaneous transpedicular screw fixation: Increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system'. Together they form a unique fingerprint.

  • Cite this