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ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 3  |  Page : 90-95

Pedicle screw placement in the thoracic and lumbar spine by the C-arm guided navigation and the free hand method: A technical and outcome analysis


1 Associate Professor, Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
2 Resident, Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
3 Professor, Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
4 Assistant Professor, Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India

Correspondence Address:
Anantha Gabbita
Associate Professor, Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.5005/jp-journals-10039-1098

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Introduction: The use of pedicle screws in stabilizing all three columns of the spine is a well-known but technically demanding procedure. Various assisted techniques like intraoperative fluoroscopy and stereotaxy-guided techniques have marginally increased placement accuracy along with increased radiation exposure to the surgeon and the patient, with an increased operative time. Over the last two decades, a detailed understanding of the anatomy of the thoracolumbar pedicles has led to the emergence of the “free-hand” technique. Objectives: To analyze the pedicle screw placement in thoracic, lumbar, and sacral spine over a 3-year period in terms of the intraoperative and immediate postoperative procedural results using navigation-guided and free hand techniques. Materials and methods: A retrospective study was done over a period of 3 years from November 2012 to December 2015 in a tertiary care center by a single surgeon, involving 118 cases that were done using the C-arm navigation and the free hand technique. Results: The study involved a total of 118 patients and 546 screws over a period of 3 years. The indications consisted of degenerative diseases (72%), infection (12.7%), trauma (12.7%), and malignancy (2.54%). The initial 77 cases were done by image guidance under C arm navigation and the later 41 cases with free hand techniques. Among these, there were eight breaches noted (6.72%), five (6.49%) in the image-guided technique vs three (7.3%) in the freehand technique. The direction of breach was lateral in one case (12.5%) and medial in seven cases (87.5%). Three patients (37.5%) with suboptimal screw placement underwent revision surgery. Four patients (3.36%) in the present study had postoperative neurological deficit in the form of foot drop and preoperative durotomies noted in nine patients (7.62%). Postoperative surgical site infections were noted in four cases (3.38%). Conclusion: Free hand pedicle screw placement based on external anatomy alone can be performed with acceptable safety and accuracy in experienced hands and allows avoidance of radiation exposure encountered in fluoroscopic techniques.


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