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The variability in width, height, and spatial orientation of a spinal pediclemakes pedicle screw insertion a delicate operation. The aim of the currentpaper is to describe a computer-assisted surgical navigation system based onfluoroscopic X-ray image calibration and three-dimensional optical localizersin order to reduce radiation exposure while increasing accuracy and reliabilityof the surgical procedure for pedicle screw insertion. Instrumentation usingtranspedicular screw fixation was performed: in a first group, a conventionalsurgical procedure was carried out with 26 patients (138 screws); in a secondgroup, a navigated surgical procedure (virtual fluoroscopy) was performed with26 patients (140 screws). Evaluation of screw placement in every case was doneby using plain X-rays and post-operative computer tomography scan. A 5 per centcortex penetration (7 of 140 pedicle screws) occurred for the computer-assistedgroup. A 13 per cent penetration (18 of 138 pedicle screws) occurred for thenon computer-assisted group. The radiation running time for each vertebra level(two screws) reached 3.5 s on average in the computer-assisted group and 11.5 son average in the non computer-assisted group. The operative time for twoscrews on the same vertebra level reaches 10 min on average in the noncomputer-assisted group and 11.9 min on average in the computer-assisted group.The fluoroscopy-based (two-dimensional) navigation system for pedicle screwinsertion is a safe and reliable procedure for surgery in the lower thoracicand lumbar spine.

Fluoroscopy-based navigation system in spine surgery