الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 154 |  |  |
| | | from | 154 | | |
Abstract
This study is to evaluate accuracy of screw placement using intraoperative Computed Tomography with navigation in dorsal and lumber spine fixation surgery. 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. Their age ranges between 20-60 years with mean 24.3 years. We had one case of upper dorsal pott’s disease ,six cases (30%) unstable thoracolumbar junction, four cases (20%) long segment lumber canal stenosis and nine cases (45%) degenerative lumber and lumbosacral spondylolisthesis. the decision was taken to do spinal fixation to all of this cases by posterior transpedicular screw fixation guided by intraoperative CT with navigation (Airo). One hundred and thirty screws were inserted at different levels of the spine according to the pathology, thirty four screw (26.1%) were inserted in the thoracic spine, seventy six screws were inserted in the lumber spine (58.46 %) and twenty screws in sacral one (15.38%). Screw insertion was guided by Airo. We started navigation by doing intraoperative CT scan to each patient at the beginning of the surgery to use it for registration and to guide navigation, and another intraoperative CT at the end of the surgery to confirm good screw positioning. In comparison to conventional techniques there were some extra steps (20-42 minutes) like system set up, preparation for CT scanning, and doing two CT scans. It has great advantage in reduction of radiation exposure to surgical team. Airo provided high quality 3D images even for the pedicles and greatly facilitate screw positioning in obese patients and also in thoracic spine as it has small sized pedicle and complex 3D anatomy, and this reflected in patient’s results so we had 105 (80.76%) perfect screws and 21(16.15%) clinically acceptable screws so accuracy was (96.91%). On the other side we had 4 (3.07%) screws grade C which were corrected intraoperatively with real-time confirmation images. Consequently revision surgery incidence declined up to zero. Using Airo prevent serious intraoperative complication as vascular, visceral and neurological injury it reduce the breach rate of transpedicular screws, but cannot eliminate the possibility of mal-positioning. Adequate cord, thecal sac and nerve roots decompression was achieved. However there is several pitfalls that reduce navigation accuracy and cause screw malplacement including mobilization of the reference frame, spine mobility between the frame and the instrumented vertebrae, and related technical errors. Airo is more costly than conventional techniques and needs roomy operating theatre and well trained surgical team.