Comparative analysis of the use of 3D navigation and «free hand» technique in the surgical treatment of idiopathic scoliosis in children
DOI:
https://doi.org/10.15574/PS.2025.2(87).5257Keywords:
idiopathic scoliosis, spinal deformity, “free hand” technique, pedicle screw, spinal surgery safety, posterior instrumentation, 3D navigation, intraoperative neurophysiological monitoringAbstract
Posterior instrumentation technique and posterior fusion with pedicle screws is a standard operation for the correction of idiopathic scoliosis. Pedicle screws can be incorrectly placed even by the best, most experienced surgeons (1.7 to 15% of cases). Improving the accuracy of screw insertion can be achieved by using standardized methods of free-hand technique screw insertion and by using navigation systems
Aim - to determine the benefits of using optical enhancement technique with navigation based on intraoperative computed tomography is more effective than the free-hand technique in the placement of pedicle screws in the surgical treatment of idiopathic scoliosis in children.
Materials and methods. The study included 90 patients with a diagnosis of idiopathic scoliosis of the thoracolumbar spine. A total of 2127 pedicle screws were inserted during the surgical treatment of idiopathic scoliosis in children. The group A included 44 patients, who received 1059 pedicle screws using the «free-hand» technique. The group B included 46 patients, who received 1068 pedicle screws using 3D-navigation with optical amplification. The accuracy of screw placement was assessed on postoperative CT scans using the Gertzbein-Robbins scale. We compared the accuracy and safety of pedicle screw placement between the both groups.
Results. The group A's rate of 90.1% was significantly lower than that of the group B's 96.5%.
Conclusions. Intraoperative computer 3D-navigation compared to the “freehand” technique has the advantage of correctness and safety of pedicle screw placement, shortens surgical time, reduce intraoperative bleeding, the number of neurological postoperative complications, and also ensure the safety of the operation by identifying and quickly removing an incorrectly placed screw. Increasing the accuracy of screw placement allows for an increase in the range of surgical interventions of higher complexity and improving the correction rates of spinal deformities in idiopathic scoliosis in children.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee for all participants. The informed consent of the patients was obtained for the study.
The authors declare no conflict of interest.
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