Placement of percutaneous thoracic pedicle screws using neuronavigation

Background: Percutaneous thoracic pedicle screw fixation is challenging because of the complexity of the spinal anatomy and obscuration of normal surgical landmarks by soft tissue. We report a novel percutaneous technique in which intraoperative Iso-C C-arm navigation was used to treat complex thoracic spinal fractures. Methods: Between March and September 2007, percutaneous thoracic pedicle screw fixation was performed with the assistance of intraoperative Iso-C C-arm fluoroscopy in six patients (two males, four females; mean age = 33 years, range = 16-61 years) with unstable thoracic fractures. The accuracy of pedicle screw placement was assessed by postoperative computed tomography and graded according to the method of Youkilis et al. Results: Five patients had unstable acute traumatic fractures and one had an osteoporotic burst fracture. Altogether, 19 spinal segments (range = 2-4/patient) were fixated using 37 pedicle screws. Pedicle screw misplacement was grade II in 16% and grade III in 3%. None of the patients had neurologic consequences due to screw misplacement, and none required conversion to an open procedure or revision of hardware. There was one wound infection. Conclusion: Percutaneous thoracic pedicle screw fixation with intraoperative neuronavigation for the stabilization of complex spinal fractures is feasible and associated with acceptable rates of accuracy and morbidity.