Pedicle screw insertion accuracy in terms of breach and reposition using a new intraoperative cone beam computed tomography imaging technique and evaluation of the factors associated with these parameters of accuracy: a series of 695 screws

Abstract

Purpose

The goals of this study were to assess the accuracy of pedicle screw insertion using an intraoperative cone beam computed tomography (CBCT) system, and to analyze the factors potentially influencing this accuracy.

Methods

Six hundred and ninety-five pedicle screws were inserted in 118 patients between October 2013 and March 2016. Screw insertion was performed using 2D-fluoroscopy or CBCT-based navigation. Accuracy was assessed in terms of breach and reposition. All the intraoperative CBCT scans, done after screw insertion, were reviewed to assess the accuracy of screw placement using two established classification systems: Gertzbein and Heary. Generalized linear mixed models were used to model the odds (95% CI) for a screw to lead to a breach according to the independent variables.

Results

The breach rate was 11.7% using the Gertzbein classification and 15.4% using the Heary classification. Seventeen screws (2.4%) were repositioned intraoperatively. The only factor affecting statistically the odds to have a breach was the indication of surgery. The patients with non-degenerative disease had a significantly higher risk of breach than those with degenerative disease.

Conclusion

Use of intraoperative CBCT as 2D-fluoroscopy or coupled with a navigation system for pedicle screw insertion is accurate in terms of breach occurrence and reposition. However, these rates depend on the classification or grading system used. Use of a navigation system does not decrease the risk of breach significantly. And the risk of breach is higher in non-degenerative conditions (trauma, scoliosis, infection, and malignancy disease) than in degenerative diseases.

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