Five years of experience in using of navigation system in spine surgery
There are various approaches to usу the navigation systems, such as: navigation based on preliminary computed tomography or intraoperative imaging using a 3D/2D fluoroscope or computer tomography. Each of these methods has its advantages and disadvantages.
Objectives: to conduct a comparative evaluation of the precision of the setting of the screws in the vertebrae and to identify the quantity of surgical revisions due to incorrect location of the screws and to compare it with the standard technique of setting screws («free-hands» technique) and inserting the screws by using a 3D navigation system.
Methods: we made a retrospective analysis of 2 760 patients over the age of 18 years. Patients were divided into two groups: I group (2 128 patients) who underwent a standard procedure («handsfree» technique) for inserting the screws, with intra- and postoperative X-ray control of screws’ location; II group (632 patients) whom the screws were inserted with «Brainlab» navigation system in the CT scan mode of the patient, in the prone position with rollers under the iliac crest.
Results: the number of surgical revisions because of wrong screws position was 37 (1.74 %) patients in the first group. In the second group, only 12 screws were reintroduced intraoperatively in 9 (1.42 %) patients, due to their not quite correct position after fluoroscopic control or neuromonitoring. As a result of the analysis of iatrogenic mistakes, we have developed a number of practical recommendations that help to prevent failures in the navigation system.
Conclusions: the usage of navigation equipment allows to reduce the time of performed surgery, to reduce the incision length of soft tissues damage, so to decrease the risk of neurologic complications and intraoperative fluoroscopy radiation exposure, to increase the complexity and range of surgical interventions, and also to set transpedicular screws more precisely.
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