Magdy Abd El Aziz Al Mahalawy, Ibrahim Mohammed Shafik, Basem Abo Elnaga, Ebrahim Shamhoot and Marian Fayez Abd Elsayed
Objective: To evaluate accuracy of screw placement using intra-operative Computed Tomography with navigation in dorsal and lumbosacral spine fixation surgery.
Patients and Methods: The study included 20 patients operated in Tanta University Hospital and Al Galaa Military Hospital in Cairo in the period from September 2018 to July 2022, all of them were having spinal instability of their thoracic, thoracolumbar, lumbar and lumbosacral spine with a male to female ratio 4:1.
Results: While using Airo lowers the breach rate of transpedicular screws and prevents major intraoperative complications such vascular, visceral, and neurological injury, it does not completely remove the risk of mispositioning. Enough decompression of the cord, thecal sac, and nerve roots was accomplished. However, a number of traps, such as reference frame mobilization, spine motion between the frame and the instrumented vertebrae, and associated technological faults, can lower navigation accuracy and result in screw malplacement. Airo requires a spacious operating room and a skilled surgical team, and it is more expensive than traditional methods.
Conclusion: Intraoperative CT with navigation reduces screw malplacement and if there is intraoperative malplacement this could be corrected immediately and consequently prohibit the need of correction surgery. CT with navigation facilitate fixation surgery in obese patients due to good quality of images also it reduces breach rate. CT with navigation facilitate fixation in thoracic spine as the pedicle is small with complex 3D anatomy. It gives information about adequate cord, thecal sac and nerve roots decompression during surgery. So intraoperative CT with navigation provide easier surgery, greater accuracy, less complications and consequently improves outcome. It declines radiation exposure to surgical team. On the other hand, still cost, wide operating theatre, well trained team and intraoperative technical errors represent challenges.
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