Computed tomography-guided intraoperative navigation in children with congenital scoliosis versus freehand/fluoroscopy methods

Abdaliyev S.S. Yestay D.Zh. Vissarionov S.V. Baitov D.T. Serikov S.Zh. Chsherbina A.Yu.
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Pediatric Traumatology, Orthopaedics and Reconstructive Surgery
2023 #11 Issue 3 307 - 314 pp.

BACKGROUND: The choice of techniques for the treatment of children with congenital spinal deformities remains one of the most significant problems of spinal surgery. This topic is relevant given the peculiarities of the disease course, severity and rigidity of deformities, their steady and rapid progression, formation of compensatory curvature, and a significant decrease in the quality and life expectancy of patients. AIM: To compare screw misposition, adverse outcomes, intraoperative blood loss, and time required for pedicle screw placement with further deformity correction under computed tomography (CT) guidance with intraoperative navigation versus fluoroscopy. MATERIALS AND METHODS: This single-center, prospective comparative study was conducted from 2019 to 2022 at the National Scientific Center of Traumatology and Orthopedics named after academician N.D. Batpenov. Patient demographics and surgical outcomes were obtained from the medical records. All patients underwent a comprehensive clinical and radiological examination before surgery, after surgery, and at the stages of dynamic observation. Data of patients with congenital malformations of the spine were analyzed. The study involved 42 patients aged 3–18 years with congenital kyphoscoliosis of the thoracic and/or lumbar spine. The patients were divided into two groups according to the method of surgical correction used: the O-arm navigation group and the C-arm group. RESULTS: Data of patients who underwent surgery for congenital scoliosis of the spine were analyzed. The patients were divided into the O-arm navigation group, which included patients who underwent surgery using the O-arm mobile intraoperative CT with the seventh-generation Stealth Station navigation system in combination with intraoperative neuromonitoring, and the C-arm group, which included patients who underwent surgery under the control of the intraoperative C-arm. In both groups, 364 screws were placed, of which 189 screws were placed under neuronavigation, and 175 screws were placed using the C-arm. The effectiveness of the intraoperative neuronavigation system in combination with neuromonitoring showed 97.11% correct placement (grades A and B) of pedicle screws. The use of an intraoperative C-arm showed 89.63% (grades A and B) correctness. The proportion of misplaced screws corresponding to Gertzbein–Robbins classes C–E was higher in the C-arm group (10.37%) than in the navigation group (1.49%) (p ≤ 0.005). No severe neurological disorders, postoperative infection, or adverse clinical outcomes were observed in both groups. CONCLUSIONS: The installation of pedicle screws using CT-guided navigation (O-arm) did not prolong the operation time, did not increase blood loss, and reduced the risk of screw mispositioning compared with freehand and fluoroscopy pedicle screw placement.

congenital spinal deformities , misposition , neuromonitoring , neuronavigation system

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National Scientific Center of Traumatology and Orthopedics named after academician N.D. Batpenov, 15A Abylai Khan Ave, Astana, 010000, Kazakhstan
Karaganda Medical University, Karaganda, Kazakhstan
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery, Saint Petersburg, Russian Federation

National Scientific Center of Traumatology and Orthopedics named after academician N.D. Batpenov
Karaganda Medical University
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

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