Comparative study of 3D navigation system and traditional C-arm camera in the treatment of thoracolumbar fracture with percutaneous pedicle screw fixation

English Keywords:Surgical navigation system  Thoracolumbar fracture  Percutaneous pedicle screw fixation

English Abstract:

  【Abstract】 Objectives: To compare the accuracy and safety of 3D navigation technique and traditional C-arm camera in the treatment of thoracolumbar fracture with percutaneous pedicle screw fixation. Methods: 53 patients with thoracolumbar fractures who underwent percutaneous pedicle screw fixation from May 2015 to December 2016 were collected. The patients were divided into two groups: in traditional group(29 cases), traditional C-arm X-ray guidance was used to assist pedicle screw positioning; in navigation group(24 cases), pedicle screw insertion was assisted by 3D navigation system. The preoperative visual analogue scale(VAS) of low back pain, mean screw placement time, puncture needle adjustment times, radiographic exposure time, intraoperative blood loss volume, 2-day postoperative VAS score of low back pain and the occurrence of postoperative complications were recorded. The screw trajectory of the two groups of pedicle screw was evaluated according to postoperative CT, and the accuracy and safety of screw placement between the two groups was compared according to the improved classification of Certzbein-Robbins. During the follow-up period, the incidence of perioperative complications and the dissolution of screws were observed. Results: There were no significant differences in age, sex, preoperative VAS score of low back pain, type of fracture and injured vertebral body distribution between the two groups. The accuracy rate of traditional group screw placement was 76.72%(89/116), and the safety rate was 95.69%(111/116); while that in navigation group was 90.63%(87/96) and 100%(96/96) respectively. There were no complications such as nerve injury and screw dissolution or fracture in the two groups. Compared with the traditional group, the navigation group had significant advantages in the intraoperative puncture needle adjustment times, 2-day postoperative VAS score of low back pain and the accuracy and safety of screw placement(P＜0.05). There was no significant difference in the intraoperative mean screw placement time on the intraoperative blood loss volume between the two groups. And in the intraoperative radiographic exposure time, the navigation group was significantly longer than the traditional group. Conclusions: 3D navigation technique can significantly improve the accuracy and safety of percutaneous pedicle screw placement in thoracolumbar fractures, but the patient may receive longer exposure time.