• Gualtiero Innocenzi, Simona Bistazzoni, Manuela D'Ercole, Giovanni Cardarelli, and Francesco Ricciardi.
• IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy. nch@neuromed.it.
• Acta Neurochir. Suppl. 2017 Jan 1; 124: 289-295.

BackgroundThe aim of our study was to assess how a preoperative computed tomography (CT)-based navigation system affected the correctness and safety of transpedicular screw insertion, compared with standard techniques.MethodBetween January 2012 and February 2014, 203 patients underwent thoracic and lumbar fixation, with open and percutaneous techniques; 218 screws were implanted through an open navigated technique (1.0 Spine & Trauma 3d ver. 2.0 BrainLab, Feldkirchen Germany) in 43 patients; 220 screws were inserted with an open free-hand technique in 45 patients; 230 screws were implanted in 56 patients using percutaneous CT-based navigation; and 236 screws were inserted in 59 patients using a percutaneous fluoroscopy-guided technique. To our knowledge, this is the first work comparing these four different techniques. The position of each screw was evaluated on CT scan reconstruction and classified according to a four-point grading scale (grade 0: no breach, grade 1: breach < 2 mm, grade 2: breach between 2 and 4 mm; grade 3: breach >4 mm). Statistical analysis was assessed by two-way analysis of variance (ANOVA) t test, while the Fisher least significant difference (LSD) method was employed to determine statistical significance.ResultsStatistical analysis showed a significant difference in accuracy between the open CT-based navigation and the percutaneous CT-based navigation techniques (P= 0.0263) and between the open CT-based navigation and the percutaneous fluoroscopy-guided techniques (P=0.0258): a particular difference was observed in anterior misplacement between open CT-based navigation and the percutaneous fluoroscopy-guided technique (P= 0.0153).ConclusionsOur results confirm the advantages of the navigation technique, which ensures greater accuracy, in open as well as percutaneous procedures.

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