Vertebral stabilization with
pedicle screws is currently considered the gold standard for many conditions,
such as degenerative, traumatic and oncologic pathologies of the spine.The need
for a more accurate surgical technique has led, during the years, to the
research of methods and technical aids in order to reach the most accurate and
safe pedicle screw placement, for clinical and medico-legal reasons.
The estimated screw misplacement
rate varies in the literature in a range from 6 to 31% with the free-hand
technique and from 15 to 72% with the fluoroscopic guided technique, the two
most widespread techniques.Recently, many different systems have been developed
in order to help the spinal surgeon in the placement of pedicle screws, and to
reduce the incidence of misplacement.
The most used system is surely the
neuronavigator. Widely known and applied in oncologic brain surgery, its
use is increasingly widespread also in spine surgery. A preoperative
surgical planning is performed on the basis of a thin slice CT scan, with a
margin of error starting from 0.5 mm.Despite its high cost, today a
neuronavigator is available in the majority of neurosurgical departments.
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