Accuracy of screw placement and radiation dose in navigated dorsal instrumentation of the cervical spine: a prospective cohort study.

BACKGROUND: Dorsal cervical spinal fusion is a challenging procedure in fracture fixation. There is limited information in the literature about computer navigation using lateral mass screws in cases of spinal trauma. METHODS: Retrospective analysis of a prospective database covering an 8 year period. All patients who received a dorsal spinal fusion due to a fracture of the cervical spine were included. Outcome parameters were screw accuracy, duration of surgery, the radiation emitted and intra-/postoperative complications. RESULTS: Sixteen patients, who received 67 screws (44 navigated vs 23 conventionally inserted screws) were included. Three-dimensional (3D)-based computer navigation prolonged the duration of surgery but helped to reduce the radiation emitted and led to significantly increased accuracy of screw positioning. CONCLUSION: Computer navigation can increase the accuracy of lateral mass screws in spinal trauma. It prolongs the surgical procedure but reduces the emission of radiation significantly.

Integration of fluoroscopy-based guidance in orthopaedic trauma surgery - a prospective cohort study.

INTRODUCTION: Computer-assisted guidance systems are not used frequently for musculoskeletal injuries unless there are potential advantages. We investigated a novel fluoroscopy-based image guidance system in orthopaedic trauma surgery. MATERIALS AND METHODS: The study was a prospective, not randomised, single-centre case series at a level I trauma centre. A total of 45 patients with 46 injuries (foot 12, shoulder 10, long bones seven, hand and wrist seven, ankle seven and spine and pelvis four) were included. Different surgical procedures were examined following the basic principles of the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF). Main outcome measurements were the number of trials for implant placement, total surgery time, usability via user questionnaire and system failure rate. RESULTS: In all cases, the trajectory function was used, inserting a total of 56 guided implants. The system failed when used in pelvic and spinal injuries, resulting in a total failure rate of 6.5% (n=3) of all included cases. The overall usability was rated as good, scoring 84.3%. CONCLUSION: The novel image-guidance system could be integrated into the surgical workflow and was used successfully in orthopaedic trauma surgery. Expected advantages should be explored in randomised studies.