• Edward Fomekong, Julien Pierrard, and Christian Raftopoulos.
• Department of Neurosurgery, Cliniques Universitaires Saint-Luc Bruxelles, Brussels, Belgium.
• World Neurosurg. 2018 Mar 1; 111: e410-e417.

BackgroundThe major limitation of computer-based three-dimensional fluoroscopy is increased radiation exposure of patients and operating room staff. Combining spine navigation with intraoperative three-dimensional fluoroscopy (io3DF) can likely overcome this shortcoming, while increasing pedicle screw accuracy rate. We compared data from a cohort of patients undergoing lumbar percutaneous pedicle screw placement using io3DF alone or in combination with spine navigation.MethodsThis study consisted of 168 patients who underwent percutaneous pedicle screw implantation between 2009 and 2016. The primary endpoint was to compare pedicle screw accuracy between the 2 groups. Secondary endpoints were to compare radiation exposure of patients and operating room staff, duration of surgery, and postoperative complications.ResultsIn group 1, 438 screws were placed without navigation guidance; in group 2, 276 screws were placed with spine navigation. Mean patient age in both groups was 58.6 ± 14.1 years. The final pedicle accuracy rate was 97.9% in group 1 and 99.6% in group 2. Average radiation dose per patient was significantly larger in group 1 (571.9 mGym2) than in group 2 (365.6 mGym2) (P = 0.000088). Surgery duration and complication rate were not significantly different between the 2 groups (P > 0.05).Conclusionsio3DF with spine navigation minimized radiation exposure of patients and operating room staff and provided an excellent percutaneous pedicle screw accuracy rate with no permanent complications compared with io3DF alone. This setup is recommended, especially for patients with a complex degenerative spine condition.Copyright © 2017 Elsevier Inc. All rights reserved.

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