O-arm navigated orthopedic electric drill-assisted percutaneous pedicle screw reduction and fixation in the treatment of lumbar burst fractures

English Keywords:Percutaneous pedicle screw  Lumbar fracture  O-arm  Three-dimensional navigation  Lumbar facet joint

English Abstract:

  【Abstract】 Objectives: To explore the clinical effects of percutaneous pedicle screw reduction and internal fixation for the treatment of lumbar burst fractures under O-arm 3D navigation and assisted with orthopedic electric drill in quickly inserting a guidewire. Methods: A retrospective analysis was conducted on 69 consecutive cases of patients who underwent percutaneous lumbar fracture reduction and internal fixation surgery under O-arm 3D navigation and C-arm 2D fluoroscopy from January 2020 to June 2024 in our hospital. The surgeries under O-arm 3D navigation were further divided into a group using a visualized bone drill to quickly insert the guide pin(group A) and a group using a minimally invasive opener to insert the guide wire in real-time visualization(group B). The patients underwent surgery under 2D fluoroscopy of the C-arm were included in group C. There were 19 patients in group A, aged 50(42-56) years; 17 patients in group B, aged 51(49-56) years; and 33 patients in group C, aged 54(44-56) years. The screw accuracy was classified using the Gertzben-Robbins classification method based on the postoperative lumbar CT axial plane, and graded using the Simplified Screw Accuracy(SSA) grade. During the follow-up of 1-2 years, CT was used to evaluate the joint facet degeneration when the fracture internal fixator was removed. The clinical surgical indicators such as operative time, screw insertion time, and blood loss, as well as post-operative 3d CT screw accuracy and lumbar facet joint hypertrophy and fusion(lumbar degeneration) at final follow-up were evaluated. Results: Group A had a surgical time of 91.68±25.31min, a blood loss of 48.95±27.87mL, and a single screw insertion time of 6.53±1.74min, which were significantly better than those of group B(101.35±24.46min, 25.88±79.22mL, 8.59±1.54min) and group C(120.12±31.29min, 140.33±80.80mL, 10.48±1.48min) (P<0.05). In terms of screw placement accuracy, in O-arm group, 183(74.7%) were excellent (0-level screw placement), 55(21.7%) and 16(6.3%) were good(Ⅰ, Ⅱ levels) and poor (Ⅲ, Ⅳ levels), while in group C, it was 114(57.6%), 60(30.3%), and 24(12.1%), and there was a significant statistical difference between the two groups(P<0.05). There was no significant statistical difference in lumbar facet joint injury between the O-arm group and the C-arm group(47 cases, 18.5% vs 51 cases, 25.8%), but after excluding the factor of deep screw placement, the joint facet joint injury and the secondary lumbar facet joint degeneration found at final follow-up CT examination were 28(11.9%) and 26(10.2%) in the O-arm group, respectively, which were superior to 38(20.5%) and 36(18.2%) in the C-arm group (P<0.05). Conclusions: Using a bone drill to quickly insert the guide wire under O-arm 3D navigation for percutaneous pedicle screw internal fixation of lumbar burst fractures is more convenient and faster than conventional O-arm navigated puncture and screw insertion. Compared with the C-arm 2D fluroscopy, O-arm 3D navigation has significantly higher screw accuracy, lower facet joint injury rate and rate of secondary facet joint degeneration at final follow-up.