International orthopaedics · 2026
Accuracy of pedicle screw insertion in single-level lumbar interbody fusion: comparison before and after the introduction of intraoperative three-dimensional computed tomography navigation.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Sato Masayuki, Katsumi Keiichi, Mizouchi Tatsuki, Ishikawa Yuya, Sekimoto Hiroyuki, Wakasugi Masashi, Yamazaki Akiyoshi
Аннотация
PURPOSE: This study aimed to evaluate pedicle screw placement accuracy, surgical complications, and reoperation rates in patients undergoing single-level lumbar interbody fusion before and after the introduction of an intraoperative three-dimensional computed tomography (3D-CT: O-arm) navigation system at our institution.
METHODS: This retrospective study included patients who underwent single-level lumbar interbody fusion for lumbar degenerative disease at the L4/5 or L5/S level. Patients treated after the introduction of the O-arm system were assigned to the O-arm group (group O), whereas those treated before its introduction were assigned to the freehand group (group F). Group O consisted of 344 consecutive cases treated between January 2016 and March 2020. Group F consisted of 304 consecutive cases treated between April 2009 and December 2011. Pedicle screw perforation was assessed using postoperative CT, and reoperations for screw malposition were recorded.
RESULTS: The overall rate of screw perforation on postoperative CT was significantly lower in group O than in group F (p < 0.001). Medial perforation occurred most frequently in group F, whereas only two cases were observed in group O. No patients in group O required reoperation for screw malposition, while four patients in group F underwent reoperation, representing a significant difference between groups (p < 0.05).
CONCLUSION: Reoperations due to pedicle screw malposition were significantly less frequent in the O-arm group than in the freehand group. The introduction of intraoperative 3D-CT navigation was associated with reduced surgical invasiveness and a lower incidence of implant-related complications, including screw-induced nerve injury, thereby improving surgical safety.
METHODS: This retrospective study included patients who underwent single-level lumbar interbody fusion for lumbar degenerative disease at the L4/5 or L5/S level. Patients treated after the introduction of the O-arm system were assigned to the O-arm group (group O), whereas those treated before its introduction were assigned to the freehand group (group F). Group O consisted of 344 consecutive cases treated between January 2016 and March 2020. Group F consisted of 304 consecutive cases treated between April 2009 and December 2011. Pedicle screw perforation was assessed using postoperative CT, and reoperations for screw malposition were recorded.
RESULTS: The overall rate of screw perforation on postoperative CT was significantly lower in group O than in group F (p < 0.001). Medial perforation occurred most frequently in group F, whereas only two cases were observed in group O. No patients in group O required reoperation for screw malposition, while four patients in group F underwent reoperation, representing a significant difference between groups (p < 0.05).
CONCLUSION: Reoperations due to pedicle screw malposition were significantly less frequent in the O-arm group than in the freehand group. The introduction of intraoperative 3D-CT navigation was associated with reduced surgical invasiveness and a lower incidence of implant-related complications, including screw-induced nerve injury, thereby improving surgical safety.