Abstract
The possible complications of a pedicle screw fixation system include injury to neurologic and vascular structures resulting from inaccurate placement of the instrumentation. In a review of 617 surgical cases in which pedicle screw implants were used, Esses and co-authors reported a overall complication rate of 27.4%. The most common intraoperative problem was unrecognized screw misplacement (5.2%). Fracturing the pedicle during screw insertion and iatrogenic cerebrospinal fluid leak occurred in 4.2% of cases. Such a complication rate is not acceptable in clinical practice. In this paper, we discuss a computer-assisted spine surgery system designed for real-time intraoperative localization of surgical instruments on precaptured images used during surgery. Localization was achieved by combining image-guided stereotaxis with advanced opto-electronic position sensing techniques. The insertion of pedicle screws can be directly monitored by interactive navigation using specially equipped surgical tools. Our preliminary results showed no misplacement of pedicle screw, which have further confirmed the clinical potential of this system.
This is a preview of subscription content, log in via an institution to check access.
Preview
Unable to display preview. Download preview PDF.
References
Esses SI, Sachs BL, Dreyzin V: Complications associated with the technique of pedicle screw fixation — A selected survey of ABS members. Spine 18 (1993) 2231–2239
Farbar GL, Place HM, Mazur RA, Casey Jones DE, Damiano TR: Accuracy of pedicle screw placement in lumbar fusion by plain radiographs and computer tomography. Spine 20 (1995) 1494–1499
Gertzbein, SD, Robbins SE: Accuracy of pedicle screw placement in vivo. Spine 15 (1990) 11–14
Kalfas IH, Kormos DW, Murphy MA, et al: Application of frameless stereotaxy to pedicle screw fixation of the spine. J Neurosurg 83 (1995) 641–647
Nolte LP, Zamorano L, Jiang Z, Wang Q, Langlots F, Berlemann U: Image-guided insertion of transpedicular screws: a laboratory set-up. Spine 20 (1995) 497–500
Nolte LP, Visarius H, Arm E, Langlots F, Schwarzenbach O: Computer-aided fixation of spinal implants. J Image Guided Surgery 1 (1995) 88–93
Steinmann JC, Herkowitz HN, El-Kommos H, Wesolowski DP: Spinal pedicle fixation-Confirmation of an image-based technique for screw placement. Spine 18 (1993) 1856–61
Vaccaro AR, Garfin SR: Internal fixation (pedicle screw fixation) for fusions of the lumbar spine. Spine 20 (1995) 157S–167S
Weinstein JN, Spratt KF, Spengler D, et al: Spinal pedicle fixation: Reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. Spine 13 (1988) 1012–1018
Wiltse LL: History of pedicle screw fixation of the spine. Spine State Art Rev 6 (1992) 1–10
Wu SS, Liang PL, Pai WM, Au MK, Lin LC: Spinal transpedicular drill guide: Design and application. J Spinal Disorders 4 (1991) 96–103
Zamorano L, Nolte LP, Kadi M, Jiang Z: Interactive intraoperative localization using an infrared-based system. Neuro Res 15 (1993) 290–298
Zamorano L, Kadi M, Dong A: Computer-assisted neurosurgery: Simulation and automation. Stereotact Funct Neurosurg 59 (1992) 115–122
Author information
Authors and Affiliations
Editor information
Rights and permissions
Copyright information
© 1996 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Li, Q.H. et al. (1996). Computer-assisted insertion of pedicle screws. In: Höhne, K.H., Kikinis, R. (eds) Visualization in Biomedical Computing. VBC 1996. Lecture Notes in Computer Science, vol 1131. Springer, Berlin, Heidelberg. https://doi.org/10.1007/BFb0047000
Download citation
DOI: https://doi.org/10.1007/BFb0047000
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-61649-8
Online ISBN: 978-3-540-70739-4
eBook Packages: Springer Book Archive