Genauigkeit und Komplikationen von Pedikelschrauben zur dorsalen Stabilisierung der Wirbelsäule - eine vergleichende Analyse navigierter und nicht navigierter Verfahren

Objective: Pedicle screws are used for stabilization of vertebral fractures. Inaccurate positioning of the screws can result in severe complications such as permanent neurological damage. Literature suggests an increased screw placement accuracy when computer assisted navigation systems are used. However, especially in the thoracic spine there is yet no clear proof for the superiority of navigated procedures versus the conventional approach. The objective of this study was to assess the placement accuracy and potential influencing factors of 3D-navigated versus conventionally inserted pedicle screws. Methods: A retrospective analysis of a prospective database at a level 1 trauma center of pedicle screw placement (3D-navigated versus conventionally placed) was carried out for dorsal spinal stabilization. Placement accuracy was assessed in three grades based on post-operative computed tomography. In addition, influencing factors such as body mass index, spinal level and experience level of the surgeon were analyzed, using a multivariate regression model. Results: The overall placement accuracy was 86 % in the conventional group vs. 79 % in the navigated group (perfect placement, grade 0). The navigated procedures were superior in the lumbar spine and the conventional ones were superior in the thoracic spine, though there was no statistically significant difference. The surgeon’s experience level and the patient’s body mass index did not influence the placement accuracy. The only significant factor of influence was the spinal segment: The higher the spinal level of screw placement, the lower the achieved placement accuracy. Conclusions: 3D-navigated and conventional methods are both safe procedures to place pedicle screws at the traumatized spine. At the moment, 3D-navigation does not significantly increase screw placement accuracy. Accuracy is lowest in the high thoracic spine level with both methods