The Study Of The Accuracy Of Lumbar Pedicle Screw Placement With Computer Assisted Navigation System

Objective: To compare and analyze the accuracy of the lumbar pedicle screw placement with the 3D computer assisted navigation system.Methods: Retrospective analysis in April 2016 to June 2017 period,the first affiliated hospital of hainan medical college admitted patients with lumbar degenerative disorders to accept posterior lumbar spinal canal decompression and interbody fusion assisted pedicle screw placement.Operation were used computer assisted navigation system or conventional pedicle screw placement.The inclusion criteria:(1)Patient with lumbar degenerative disease after more than three months conservative treatment,and no improvement in symptoms.The symptoms,signs and imaging findings of the patients were consistent with the etiology,and the patients required surgical treatment.(2)The surgical methods of the patients were all posterior decompression intervertebral bone grafting and pedicle internal fixation,and the lumbar pedicle screw fixation segment was L3-S1.(3)The preoperative imaging information is complete(lumbar positive side,lumbar MRI and lumbar CT three dimensional reconstruction)(4)postoperative patients were performed related imaging examination within one week(lumbar positive side and lumbar CT three dimensional reconstruction)(5)the patients were informed consent.75 patients were included in this study.There were 43 cases in 3D computer assisted navigation group and 32 cases in the manual nail group.Among the 43 patients in the navigation group,including 16 males and 27 females,age between 23-80 years old,mean age 54.9 years,19 lumbar disc herniation,24 degenerative lumbar spinal stenosis,218 lumbar screw,including L3 vertebral body 274,L4 vertebral body 696,L5 vertebral body 84,S1 vertebral 38;Among the 32 patients in the manual nail group,including 14 males and 18 females,age between 30-75 years old,mean age 53.2 years.14 lumbar disc herniation,18 degenerative lumbar spinal stenosis,178 lumbar screw,L3 vertebral body 284,L4 vertebral body 584,L5 vertebral body 62,S1 vertebral 30;Non-parametric test...Comparisons between two groups in accuracy of pedicle screw placement and wear out rate were conducted.Results: A total of 218 screws were placed in the navigation group.The reliability rate was 90.8%(198 of 218 screws)and the misplacement rate was 9.2%(20 of 218 screws).The incidence of grade 1 was 3.2%(7 of 218 screws),and the incidence of grade 2 was 5.0%(11 of 218 screws),and the incidence of grade 3 was 0.9%(2 of 218 screws).Medial cortical perforation(MCP)rate is: 3.7%(8 of 218 screws),the lateral cortical perforation(LCP)rate was 0.9%(2 of 218 screws),anterior cortical perforation(ACP)rate was 4.6%(10 of 218 screws),upper endplate perforation(EPP)rate was 0%(0 of 218 screws),intervertebral foraminal perforation(FP)rate was 0%(0 of 218 screws).A total of 178 screws were placed in the conventional group.The reliability rate was 81.46%(145 of 178 screws)and the misplacement rate was 18.54%(33 of 178 screws).The incidence rate of grade 1 was 6.74%(12 of 178 screws),and the incidence of grade 2 was 7.87%(14 of 178 screws)and the incidence of grade 3 was 3.93%(7 of 178 screws).Medial cortical perforation(MCP)rate was 8.99%(16 of 178 screws),lateral cortical perforation(LCP)rate was 5.06%(9 of 178 screws),anterior cortical perforation(ACP)was 4.49%(87 of 178 screws),upper endplate perforation(EPP)rate was 0%(0 of 178 screws),intervertebral foraminal perforation(FP)rate was 0%(0 of 178 screws).The analysis has shown that the navigation group can be performed more effectively than conventional group(P = 0.003).navigation group occurred in the process of nailing the worn out of the medial cortex rate is lower than the unarmed nailing group(P﹤0.0061),a low rate of wear out of the lateral cortex than unarmed nailing group(P﹤0.0061).Medial displacement in 8 screws in the navigation group(3.7%)and 16 in conventional group(8.99%;P﹤0.0061),and lateral displacement in 2 in navigation group(0.9%)and 9 in conventional group(5.06%;P﹤0.0061).Medially and lateral,screw deviation was more frequently in the conventional group.Conclusions: Pedicle screw placement for the clinical operative treatment of lumbar vertebral degenerative disease in the lumbosacral spine can be performed accurately with computer assisted navigation system.As we all know,Computer assisted navigation system were real-time and high precision,and these characteristics provided reliable technical support with accuracy and minimally invasive in spinal surgery.Especially in complicated spinal surgery,these advantages are more obvious;With the upgrading of navigation equipment,the clinical application value will be further explored.