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Fluoroscopy navigation method improved control of lumbar pedicle screw placement

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BOSTON — An easy-to-teach spine navigation method involving regular fluoroscopy only was safe and accurate when used to place lumbar pedicle screws, according to a presenter at the Congress of Neurological Surgeons Annual Meeting, here.

During the International Forum, Salah Al-Akkad, MD, FRCSC, FACS, DABNS, discussed results from a study in which the new technique was used in 37 adult patients who had 196 lumbar pedicle screws placed.

Most of the patients required surgery due to low-grade spondylolisthesis. Patients with scoliosis were excluded from the study.

The basis of the fluoroscopic-based navigation method is the consideration of the pedicle as having a cylinder design. Al-Akkad demonstrated how he comes in at the beginning of the pedicle and extends virtually to the isthmus to reach the middle. Overall, this supports better control of the pedicle screw placement in the lumbar spine, he said.

Only fluoroscopic images were used to target the pedicles in the study cohort.

“The most important thing is the radiology technician who takes the lateral and AP pictures,” Al-Akkad said, explaining that the upper endplate must show as a single, straight line on the AP image, with the spinous process in the middle.

He suggested getting just one lateral image and choosing the midpoint from it, if possible.

Based on the findings, there was a 2.6% screw misplacement rate, with five screws in all that were misplaced.

“The advantage of the fluoro-navigation is you can have up to 20 images navigated at the same time, “Al-Akkad said. “The best trajectory you will get is with the perfect endplate and midline.”

Al-Akkad showed examples of the technique carried out with BrainLab and Medtronic navigation systems.

Residents should be taught the procedure open, but it can be done minimally invasively, as well, Al-Akkad said. — by Susan M. Rapp

Reference:

Al Akkad S. Paper #734. Presented at: Congress of Neurological Surgeons Annual Meeting; Oct. 18-22, 2014; Boston.

Disclosure: Al Akkad has no relevant financial disclosures.