Comparative study between conventional flouroscopic vs computer assisted navigation for pedicle screw fixation

Prasanna Gunasena, Anil Weerasinghe, SD Ratnapala, Dilshan Munidasa, Nadeera Weerasinghe, Loranthi Samarasinghe

Neurosurgical Unit Lanka Hospitals, Sri Lanka

Introduction

A comparative study to assess the outcome between Conventional fluoroscopic vs Computer navigation assisted pedicle screw fixation, with regard to precision of screw placement and post-op recovery.

Material and methods

A total of 91 patients between Dec-2010 to Aug-2015, out of which 62 fluoroscopic and 29 navigation assisted screw fixations were analyzed. All cases were done posteriorly and included degenerative Spondylolisthesis, traumatic, and tumours of the Thoraco-lumbar-sacral spine. Average hospital stay, surgical time, exposure to radiation and revision rate were assessed.

Result

The average surgical time in the navigation group was 11/2-2hrs and 2-3hrs in the fluoroscopic group. Radiation exposure to the operating team was nil in the navigation group where as significant in the fluoroscopic group. The average hospital stay in the navigation group was 2-3 days where as 4-5 days in the other group.  4 patients in the fluoroscopic group had to undergo revision surgery (6.5%) compared to zero revision rate in the navigation group. CT scans were done for 2 patients in the navigation group complaining of back pain. The CT scans showed good screw position in both patients, 1 patient had post-op surgical site infection and in the other patient it was muscular pain due to positioning on the operating table.

Conclusion

Navigation assisted pedicle screw fixation is an effective method for accurate screw placement with reduced hospital stay and revision rates. Although initial setup times were longer with navigation surgery it decreases radiation exposure without increasing the overall surgical time.