THE 3D-CT NAVIGATION TECHNOLOGY FOR SURGICAL TREATMENT OF CHILDREN WITH IDIOPATHIC SCOLIOSIS

Objective. To study an applicability of active optical 3D-CT navigation system for surgical treatment of children with idiopathic scoliosis.

Material and Methods. The study included 12 children aged 14-17 years with thoracic and thoracolumbar idiopathic scoliosis. The magnitude of scoliotic deformity varied from 52° to 80° (average 70°). Correction of deformity was performed using multisegmental pedicle screw instrumentation inserted under the guidance of active optical 3D-CT navigation system. At the stage of navigation an estimation of mean-square registration error, and monitoring of time required for registration and formation of bone canals for pedicle screws were performed.

Results. In 96.6 % of cases the pedicle screws were placed in all preplanned pedicles. In other 9 vertebrae (3.4 %) the screw placement was complicated by pedicle fracture and screw trajectory deviation. There were no cases of neurological and infection complications, and instrumentation loosening in the studied patients.

Conclusion. Active optical 3D-CT navigation using preoperative CT images and anatomical landmark registration is applicable in correction of idiopathic scoliosis in children. Multisegmental transpedicular fixation allows reducing the length of metal fixation zone, and achieving maximum curve correction and reliable stability. 

1. Amiot LP, Lang K, Putzier M, et al. Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine. 2000;25:606-614.

2. Belmont PJ, Klemme WR, Dhawan A, et al. In vivo accuracy of thoracic pedicle screws. Spine. 2001;26:2340-2346.

3. Gebhard FT, Kraus MD, Schneider E, et al. Does computer-assisted spine surgery reduce intraoperative radiation doses? Spine. 2006;31:2024-2028.

4. Ishikawa Y, Kanemura T, Yoshida G, et al. Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: a retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement. J Neurosurg Spine. 2010;13:606-611.

5. Jarvers JS, Katscher S, Franck A, et al. 3D-based navigation in posterior stabilisations of the cervical and thoracic spine: problems and benefits. Results of 451 screws. Eur J Trauma Emerg Surg. 2011;37:109-119.

6. Karatoprak О, Unay К, Tezer М, et al. Mirzanli1 С. Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery. Int Orthop. 2008;32:523-528.

7. Kim YJ, Lenke LG, Kim J, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine. 2006;31:291-298.

8. Kotani Y, Abumi K, Oto M, et al. Improved accuracy of computer-assisted cervical pedicle screw insertion. J Neurosurg. 2003;99:257-263.

9. Laine T, Lund T, Ylikoski M, et al. Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J. 2000;9:235-240.

10. Liljenqvist U, Lepsien U, Hackenberg L, et al. Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis. Eur Spine J. 2002;11:336-343.

11. Nottmeier EW, Seemer W, Young PM. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine.2009;10:33-39.

12. Rajan VV, Kamath V, Shetty AP, et al. Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine. Indian J Orthop. 2010;44:163-168.

13. Suk SI, Kim WJ, Kim JH, et al. Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between multiple-hook and segmental pedicle screw fixation in adolescent idiopathic scoliosis. J Spinal Disord. 1999;12:489-495.

14. Tian NF, Huang QS, Zhou P, et al. Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur Spine J. 2011;20:846-859.

15. Tian NF, Xu HZ. Image-guided pedicle screw insertion accuracy: a meta-analysis. Int Orthop. 2009;33:895-903.

16. Tormenti MJ, Kostov DB, Gardner PA, et al. Intraoperative computed tomography image-guided navigation for posterior thoracolumbar spinal instrumentation in spinal deformity surgery. Neurosurg Focus. 2010;28:E11.