Comparison of the accuracies of atlantoaxial screw placement assisted by O-arm navigation, 3D printed guide plate, and C-arm

English Keywords:Atlantoaxial  Lateral mass screw  Pedicle screw  O-arm navigation  3D printed guide plate  Freehand placement

English Abstract:

  【Abstract】 Objectives: To compare and analyze the accuracy and safety of O-arm navigation, individualized 3D printed guide plate, and C-arm X-ray machine assisted atlantal lateral mass screw placement and axial pedicle screw placement. Methods: The clinical data of patients who underwent atlantoaxial internal fixation in our hospital from January 2015 to December 2020 were analyzed retrospectively. According to the inclusion and exclusion criteria, a total of 47 patients were enrolled, including 28 males and 19 females. The age ranged from 15 to 59 years, with an average of 46.2±10.0 years. The patients were divided into navigation group(O-arm navigation assissted, 11 cases), guide plate group(3D printed guide plate assissted, 15 cases), fluoroscopy group(freehand underC-arm fluoroscopy combined with anatomical signs, 21 cases) according to different atlantoaxial screw placement methods. The operative time, screw placement time, intraoperative blood loss, one-time success rate, screw accuracy, and complications were collected and compared between the three groups. Results: The guide plate group was less in operative time(97.5±9.0min), screw placement time(15.8±1.9min), and the intraoperative blood loss(162.7±18.5ml) than those of the navigation group(120.7±11.1min, 20.0±1.1min, and 225.8±25.6ml) and the fluoroscopy group(121.0±2.8min, 19.4±2.1min, and 239.0±24.5ml)(P<0.05). A total of 188 atlantoaxial screws were inserted, and the one-time success rate of screw placement was 100%(44/44) in the navigation group, 93.3%(56/60) in the guide plate group, and 80.9%(68/84) in the fluoroscopy group, which was higher in the navigation group than the other two groups(P<0.05). According to the grades of screw placement of 0, 1, 2, and 3, the accuracy of screw placement was 100%(44/0/0/0) in the navigation group, 98.3%(59/1/0/0) in the guide plate group, and 85.7%(72/6/3/3) in the fluoroscopy group, which was lower in the fluoroscopy group than that in the other two groups(P<0.05). In the fluoroscopy group, three screws were inserted into the vertebral artery foramen, and no cerebral ischemia or other related manifestations were found. Two patients experienced postoperative occipitocervical pain in the fluoroscopy group due to stimulation of C2 nerve root during operation, which was relieved after treatment with glucocorticoid and dehydrating agent. No patients of the other two groups experienced postoperative occipitocervical pain. The incision of the three groups of patients all healed in one stage without incision or deep infection. Conclusions: Both O-arm navigation system and individualized 3D printed guide plate assisted atlantoaxial screw placement can achieve high accuracy, which are better than the traditional freehand screw placement technique under C-arm fluoroscopy; O-arm navigation technology superiors in the one-time success rate of atlantoaxial screw placement; Individualized 3D printed guide plate can save operative time and reduce bleeding while accurately placing atlantoaxial screws.