Journal of Spinal Disorders & Techniques最新文献

{"title":"Anterior Cervical Decompression and Fusion Versus Cervical Disk Arthroplasty.","authors":"Iain S Elliott, William R Spiker, Adam M Caputo, Bruce V Darden","doi":"10.1097/BSD.0000000000000324","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000324","url":null,"abstract":"Anterior cervical discectomy and fusion (ACDF) has been successfully used for over 50 years and is considered the standard of care for the treatment of anterior cervical stenosis resulting in cervical radiculopathy or myelopathy. Although ACDF has been shown to be a safe and effective procedure, nontrivial rates of adjacent segment degeneration (ASD) can lead to a need for revision surgery on the caudad or the cephalad levels. ASD necessitating revision surgery after an ACDF occurs at approximately a 2.9% per year rate during the first 10 years after the operation.1 In response to the development of ASD, cervical disk replacement (CDR) was developed to minimize ASD by maintaining motion and thus removing the mechanical impact of fusion on the adjacent disk spaces. The impact of fusion on ASD has been studied extensively. Several studies have shown that patients who underwent foraminotomy without fusion also developed ASD at relatively similar rates to those reported for patients with ACDF, suggesting that mechanical stress related to fusion is not likely to be the causal factor in the development of ASD. Further, Hilibrand et al1 showed a decreased rate of ASD in multilevel ACDFs compared with single-level ACDFs, suggesting that by fusing the “at-risk” levels they were able to avoid ASD. If a mechanical cause was to blame for ASD, we would expect to see increased ASD in patients with longer fused segments and more motion and stress placed on the cranial and caudal disks. Reitman et al4 provided further evidence against this mechanical theory of ASD in an in vivo study. They found no statistical difference in preoperative versus postoperative motion at adjacent segments after ACDF at 10 months. With the advent of CDR, many randomized studies have been performed to compare disk replacement with ACDF (Table 1). These studies have focused on patientreported outcomes using the Neck Disability Index (NDI), Short Form Health Survey (SF-36), and Visual Analog Scale (VAS) scales, and few have analyzed ASD specifically. Harrod and colleagues analyzed the available evidence of the rates of radiographic evidence of adjacent segment pathology and clinical adjacent segment pathology in 2012. They concluded that there was moderate evidence to support no difference in the rates of radiographic evidence of adjacent segment pathology or clinical adjacent segment pathology at the short-term and mid-term time follow-up periods between the uses of CDR and ACDF.5 Verma and colleagues performed a meta-analysis of prospective randomized studies comparing ACDF to CDR and found no statistically significant difference in the rates of adjacent segment disease (ASDI) between the 2 groups. There were 777 patients in the ACDF group, 36 of which required surgery to address ASD, and 809 in the CDR group, 30 of which required surgery to address ASD. Boselie and colleagues performed a Cochrane Systematic Review of the literature comparing CDR versus ACDF. They found that CDR had m","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"309-12"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34153741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Epidural Hematomas in the Lumbar Spine.","authors":"Gregory D Schroeder,&nbsp;Mark F Kurd,&nbsp;Christopher K Kepler,&nbsp;Paul M Arnold,&nbsp;Alexander R Vaccaro","doi":"10.1097/BSD.0000000000000329","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000329","url":null,"abstract":"<p><p>Postoperative epidural hematomas are rare complications following lumbar spine surgery, but if they are not quickly identified and treated they can lead to permanent neurological deficits. Epidural hematomas occur in approximately 0.10%-0.24% of all spine surgeries, and despite the fact that multiple large studies have been performed attempting to identify risk factors for this complication, there is still significant debate about the effect of subfascial drains, postoperative anticoagulation, and antiplatelet medication on the incidence of postoperative hematoma. The purpose of this manuscript is to review the epidemiology, etiology, diagnosis, and treatment of patients who develop a postoperative lumbar epidural hematoma. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"313-8"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000329","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34102968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outside of Statistics, the Word \"Regress\" Means Going Backward. So Why Is Regression Such a Valued Statistical Tool?","authors":"Mitchell Maltenfort","doi":"10.1097/BSD.0000000000000330","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000330","url":null,"abstract":"<p><p>Regression models are commonly used in spine research today, and they can be used to explain or predict an outcome. A regression model can indicate the relative impact of each variable on the expected outcome, so when the model has been developed, it can be used to predict the outcome for a hypothetical patient. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"330-1"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000330","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34153742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expression of Concern.","authors":"Alexander R Vaccaro,&nbsp;Gregory D Schroeder","doi":"10.1097/BSD.0000000000000333","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000333","url":null,"abstract":"","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"E551"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34102969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Treatment Effects of Lumbar Arthrodeses in Degenerative Disk Disease: A Systematic Review With Meta-Analysis.","authors":"Andriy Noshchenko,&nbsp;Lilian Hoffecker,&nbsp;Emily M Lindley,&nbsp;Evalina L Burger,&nbsp;Christopher M J Cain,&nbsp;Vikas V Patel","doi":"10.1097/BSD.0000000000000124","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000124","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review with meta-analysis.</p><p><strong>Objective: </strong>To (1) evaluate long-term patient-centered clinical outcomes after lumbar arthrodesis with or without decompression for lumbar spondylosis (LS); and (2) compare these outcomes with those of alternative treatments, including nonsurgical and surgical which maintain mobility of the lumbar spine.</p><p><strong>Summary of background data: </strong>The effective treatment of LS is a complex clinical and economic concern for patients and health care providers.</p><p><strong>Methods: </strong></p><p><strong>Selection criteria: </strong>(1) randomized controlled clinical trials (RCTs) comparing treatment effects of lumbar arthrodesis with other interventions; (2) participants: skeletally mature adults with lumbar degenerative disk disease.</p><p><strong>Search methods: </strong>Ovid MEDLINE, Embase, the Cochrane Library, and others. All years through February of 2013 were included. Patient-centered clinical outcomes before treatment, at 12, 24, or >24 months of follow-up, and rate of complications and additional surgical treatment were collected. A meta-analysis was performed to evaluate pooled treatment effects. The GRADE approach was applied to evaluate the level of evidence.</p><p><strong>Results: </strong>The review included 38 studies of 5738 participants. All studies showed strong or at least moderate treatment effects of lumbar arthrodesis at 12, 24, and 48-72 months of follow-up. The level of evidence was moderate at 12 and 24 months, and low at 48-72 months. The pooled long-term treatment effect of lumbar arthrodesis exceeded those of: nonsurgical treatment (P<0.0001) with a moderate level of evidence, and decompression without fusion (P=0.005) with a low level of evidence. The treatment effect of lumbar arthrodesis showed a small inferiority versus arthroplasty at 12 and 24 months of follow-up (P<0.001), but not after 24 months postoperative.</p><p><strong>Conclusions: </strong>This review indicates that surgical stabilization of the lumbar spine is an effective treatment for LS; in particular, for patients with severe chronic low back pain that has been resistant to ≥3 months of conservative therapy.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"E493-521"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32402042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Strategy in Health Care.","authors":"Alok D Sharan,&nbsp;Gregory D Schroeder,&nbsp;Paul W Millhouse,&nbsp;Michael E West,&nbsp;Alexander R Vaccaro","doi":"10.1097/BSD.0000000000000325","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000325","url":null,"abstract":"<p><p>Significant changes are occurring in the health care field, and spine surgeons must have an understanding of business strategy if they are going to adapt to the new health care environment. Spine surgeons will be required to demonstrate how their service provides a unique value to their patients or else the patients will obtain care from competitors. Classic methods for demonstrating value such as academic prestige and superior clinical outcomes may no longer be sufficient in the evolving health care field, and surgeons will need to demonstrate a comprehensive and cost-effective treatment algorithm for a diagnosis. This article will discuss the basics of business strategy for the spine surgeon, and ways in which the surgeon may demonstrate value to their patients. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"332-4"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34153743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Wake-up Test and Combined TES-MEP and CSEP Monitoring in Spinal Surgery.","authors":"Bailing Chen,&nbsp;Yuguang Chen,&nbsp;Junlin Yang,&nbsp;Denghui Xie,&nbsp;Haihua Su,&nbsp;Fobao Li,&nbsp;Yong Wan,&nbsp;Xinsheng Peng,&nbsp;Zhaomin Zheng","doi":"10.1097/BSD.0b013e3182aa736d","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182aa736d","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective clinical analysis.</p><p><strong>Objective: </strong>The aim of this study was to compare the effectiveness of the wake-up test with that of combined monitoring of transcranial electrical stimulation motor evoked potentials (TES-MEP) and cortical somatosensory evoked potentials (CSEP) in spinal surgery.</p><p><strong>Summary of background data: </strong>TES-MEP/CSEP combined monitoring is being increasingly recognized as the ideal approach to detect spinal neurophysiological compromise during spinal surgery; however, as a result the merit of the wake-up test is now in doubt.</p><p><strong>Materials and methods: </strong>TES-MEP/CSEP combined monitoring was performed simultaneously in 426 patients who underwent spinal surgery at our department, and wake-up tests were conducted on 23 patients because of positive neurophysiological monitoring results with uncertain causes or persistent positive monitoring findings after all potential causes had been resolved. Preoperative and postoperative neurological examinations were performed as the gold standard to detect irreversible spinal function compromise. All data were collected to compare the efficiency of TES-MEP/CSEP combined monitoring with that of the wake-up test.</p><p><strong>Results: </strong>Positive results of TES-MEP/CSEP combined monitoring were recorded in 64 cases. Among them, the positive monitoring findings agreed with the results of the neurological examination in 51 cases, and the monitoring results did not match that of neurological examination in 13 cases. No false-negative result was observed. The sensitivity of TES-MEP/CSEP monitoring was 100%, the specificity was 96.5%, and the Youden index was 0.965. Wake-up tests were conducted in 23 cases. In 8 patients the positive monitoring findings completely matched the postoperative neurological examination results. In contrast, in the other 15 cases with negative neurophysiological monitoring results, only 9 patients retained intact neurological function and 6 patients suffered compromised neurological function. The sensitivity of the wake-up test was 57.1%, the specificity was 100%, and the Youden index was 0.571.</p><p><strong>Conclusions: </strong>Combined TES-MEP and CSEP monitoring, with its high sensitivity and specificity, is an effective method for monitoring spinal function during surgery and should be the preferred choice. The wake-up test is a useful complementary method for monitoring because of its high specificity.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"335-40"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182aa736d","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31819490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Pedicle Screw Placement in the Lumbar Spine: A Comparison Study Between the Novel Guidance System and the Conventional Fluoroscopy Method.","authors":"Guangfei Gu,&nbsp;Hailong Zhang,&nbsp;Shisheng He,&nbsp;Xiaobing Cai,&nbsp;Xin Gu,&nbsp;Jianbo Jia,&nbsp;Qingsong Fu,&nbsp;Xu Zhou","doi":"10.1097/BSD.0b013e3182aab222","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182aab222","url":null,"abstract":"<p><strong>Study design: </strong>The clinical study was conducted on 145 patients who received either a novel guidance method or a conventional fluoroscopic method for the percutaneous pedicle screw placement in the lumbar spine.</p><p><strong>Objective: </strong>The aim of this study was to introduce a novel guidance method for percutaneous pedicle screw placement and to compare it with the conventional fluoroscopic method.</p><p><strong>Summary of background data: </strong>Conventional fluoroscopic method was associated with a long screw placement and a more fluoroscopy time. The novel guidance system effectively minimized the insertion and the radiation exposure times.</p><p><strong>Methods: </strong>A total of 145 patients were divided into 2 groups. A total of 65 patients (group A) underwent 152 percutaneous pedicle screw fixation by conventional fluoroscopic method. A total of 80 patients (group B) underwent 185 percutaneous pedicle screw fixation by a novel guidance method. Age, body mass index, and sex ratio were comparable between the 2 groups (P>0.05). The time of insertion, radiation exposure, and accuracy of the screw placement between the 2 groups were compared.</p><p><strong>Results: </strong>The mean time for a single pedicle screw placement was found to be 15.11±3.32 minutes in group A and 10.35±2.82 minutes in group B, respectively. The average radiation exposure was 9.06±2.15 s in group B and 13.07±3.06 s in group A, respectively. The differences were statistically significant for both screw placement and radiation exposure times (P<0.05). A total of 131 screws (86.2%) in group A and 163 screws (88.1%) in group B were perfectly located within the pedicle. The statistical difference was not significant (χ=0.277, P=0.598).</p><p><strong>Conclusions: </strong>The novel guidance system significantly reduced the insertion time and radiation exposure, provided the screw placement was accurately performed when compared with the conventional method.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"E522-7"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182aab222","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31768951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Accuracy of Minimally Invasive Transpedicular Screw Placement in the Lumbar Spine With 3-Dimensional Stereotactic Image Guidance: A Comparative Meta-Analysis.","authors":"Austin C Bourgeois,&nbsp;Austin R Faulkner,&nbsp;Yong C Bradley,&nbsp;Alexander S Pasciak,&nbsp;Patrick B Barlow,&nbsp;Judson R Gash,&nbsp;William S Reid","doi":"10.1097/BSD.0000000000000152","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000152","url":null,"abstract":"<p><strong>Study design: </strong>This study compares the accuracy rates of lumbar percutaneous pedicle screw placement (PPSP) using either 2-dimensional (2-D) fluoroscopic guidance or 3-dimensional (3-D) stereotactic navigation in the setting of minimally invasive spine surgery (MISS). This represents the largest single-operator study of its kind and first comprehensive review of 3-D stereotactic navigation in the setting of MISS.</p><p><strong>Objective: </strong>To examine differences in accuracy of lumbar pedicle screw placement using 2-D fluoroscopic navigation and 3-D stereotaxis in the setting of MISS.</p><p><strong>Summary of background data: </strong>Surgeons increasingly rely upon advanced image guidance systems to guide minimally invasive PPSP. Three-dimensional stereotactic navigation with intraoperative computed tomography offers well-documented benefit in open surgical approaches. However, the utility of 3-D stereotaxis in the setting of MISS remains incompletely explored by few studies with limited patient numbers.</p><p><strong>Materials and methods: </strong>A total of 599 consecutive patients underwent minimally invasive lumbar PPSP aided by 3-D stereotactic navigation. Postoperative imaging and medical records were analyzed for patient demographics, incidence and degree of pedicle breach, and other surgical complications. A total of 2132 screw were reviewed and compared with a meta-analysis created from published data regarding the placement of 4248 fluoroscopically navigated pedicle screws in the setting of MISS.</p><p><strong>Results: </strong>In the 3-D navigation group, a total of 7 pedicle breaches occurred in 6 patients, corresponding to a per-person breach rate of 1.15% (6/518) and a per-screw breach rate of 0.33% (7/2132). Meta-analysis comprised of data from 10 independent studies showed overall breach risk of 13.1% when 2-D fluoroscopic navigation was utilized in MISS. This translates to a 99% decrease in odds of breach in the 3-D navigation technique versus the traditional 2-D-guided technique, with an odds ratio of 0.01, (95% confidence interval, 0.01-0.03), P<0.001.</p><p><strong>Conclusions: </strong>Three-dimensional stereotactic navigation based upon intraoperative computed tomography imaging offers markedly improved accuracy of percutaneous lumbar pedicle screw placement when used in the setting of MISS.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"324-9"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32558023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Navigation Improve Accuracy of Placement of Pedicle Screws in Single-level Lumbar Degenerative Spondylolisthesis?: A Comparison Between Free-hand and Three-dimensional O-Arm Navigation Techniques.","authors":"Benjamin Phak Boon Tow,&nbsp;Wai Mun Yue,&nbsp;Abhishek Srivastava,&nbsp;Jenn Ming Lai,&nbsp;Chang Ming Guo,&nbsp;Benedict Chan Wearn Peng,&nbsp;John L T Chen,&nbsp;Andy K S Yew,&nbsp;Chusheng Seng,&nbsp;Seang Beng Tan","doi":"10.1097/BSD.0b013e3182a9435e","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182a9435e","url":null,"abstract":"<p><strong>Study design: </strong>This was a prospective, nonrandomized study.</p><p><strong>Objectives: </strong>To assess the accuracy of O-arm navigation-based pedicle screw insertion in lumbar degenerative spondylolisthesis and to compare it with free-hand pedicle screw insertion technique in matched population.</p><p><strong>Summary of background data: </strong>O-arm navigation is latest in navigation technology that can provide real-time intraoperative images in 3 dimensions while placing the pedicle screws to improve intraoperative pedicle screw accuracy. Degenerative lumbar spondylolisthesis is a locally unstable pathology and placement of pedicle screws can cause increased rotation and translation of the vertebral body. However, is this motion detected by the tracker placed across the unstable segment, is a matter of debate. Inability to detect these positional changes can lead to pedicle perforation while inserting screws using navigation. No study has evaluated the role of O-arm navigation in this patient population.</p><p><strong>Materials and methods: </strong>The study population was divided into 2 groups with 19 patients each, one comprising patients who underwent O-arm navigation-based pedicle screw insertion (group 1) and the other comprising patients who underwent free-hand pedicle screw insertion technique (group 2). A total of 152 pedicle screws were implanted in 38 patients for 1-level instrumented fusion for degenerative lumbar spondylolisthesis. Intraoperative 3-dimensional computed tomography scans using the O-arm were obtained for all patients after insertion of pedicle screws. The images were reviewed intraoperatively and postoperatively for the analysis of pedicle breaches. Assessments in either of the group included (i) accuracy of placement of screws; (ii) the rate and direction of perforation; and (iii) the number of segments the perforated screw was away from the navigation tracker.</p><p><strong>Results: </strong>Mean age of patients in group 1 (O-arm navigation-assisted) was 60 years (SD 11.25; range, 37-73 y), whereas in group 2 (free-hand pedicle screw) was 62 years (SD 18.07; range, 36-90 y). Overall anatomic perforation rate was 12.5% (19/152). Individually, group 1 had 14.47% (11/76) of perforations in comparison with 10.53% (8/76) observed in group 2. The difference was not statistically significant. The lateral margin was the most common site of perforation in both group 1 (64%, 7/11) and group 2 (62.5%, 5/8). Functional perforation rate for the series was 3.3% (5/152), with group 1 having 2.63% (2/76) and group 2 having 3.95% (3/76). The rate of perforation (PR) was significantly higher statistically when the tracker was placed 3 or more [PR 37.5% (6/16)] spinal segments away from instrumented segment compared with when it was placed 1 (0%) or 2 [PR 13.89% (5/36)] spinal segments away. Overall, 11 screws (11/152, 7.24%) had grade 2 perforations and had to be revised. No neurological complications were obse","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"E472-7"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182a9435e","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31688240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}