Application of spinal navigation with the intra-operative three-dimensional (3D)-imaging modality in difficult pedicle screw fixation

The aim of this study was to evaluate the efficacy and safety of an application using spinal navigation with the intra-operative three-dimensional (3D)-imaging modality in difficult pedicle screw fixation. 78 patients with congenital deformity of spinal column and spinal cord (41 cases) or spinal instability after laminectomy or semi-laminectomy (37 cases) were instrumented with pedicle screw system by spinal navigation with the intra-operative 3D-imaging system from September 2004 to September 2014 in our orthopedic department. The position of pedicle screw was assessed by intra-operative 3D-imaging system. The excellent rate of pedicle screw position, mean time of pedicle screw implanted, operating time, blood loss, post-operative complication were recorded. The excellent rate of pedicle screw position was 96% in these cases. The mean time of pedicle screw implanted, operating time and blood loss were 3.90 +/- 0.87 minutes, 147 +/- 65 minutes and 312 +/- 185 ml, respectively. There was no implant-related complication that occurred during operation. With spinal navigation combined with the intra-operative 3D-imaging modality, implantation of difficult pedicle screw in patients with congenital spinal deformity or spinal instability after laminectomy or semi-laminectomy is more simplified, more accurate, safer, and shorter time-consuming.