{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:24:03Z","timestamp":1794324243961,"version":"4.9.0"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2009,1]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>The goal of this study was to analyze the placement accuracy and complications of thoracolumbar pedicle screws (PSs) inserted using 3D image guidance in a large patient cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors reviewed the charts of 220 consecutive patients undergoing posterior spinal fusion using 3D image guidance for instrumentation placement. A total of 1084 thoracolumbar PSs were placed using either the BrainLAB Vector Vision (BrainLAB, Inc.) or Medtronic StealthStation Treon (Medtronic, Inc.) image guidance systems. Postoperative CT scanning was performed in 184 patients, allowing for 951 screws to be graded by an independent radiologist for bone breach. All complications resulting from instrumentation placement were noted. Using the intraoperative planning function of the image-guided system, the largest diameter screw possible in each particular case was placed. The screw diameter of instrumentation placed into the L3\u2013S1 levels was noted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No vascular or visceral complications occurred as a result of screw placement. Two nerve root injuries occurred in 1084 screws placed, resulting in a 0.2% per screw incidence and a 0.9% patient incidence of nerve root injury. Neither nerve root injury was associated with a motor deficit. The breach rate was 7.5%. Grade 1 and minor anterolateral \u201ctip out\u201d breaches accounted for 90% of the total breaches. Patients undergoing revision surgery accounted for 46% of the patients in this study. Accordingly, 154 screws placed through previous fusion mass could be evaluated using postoperative CT scanning. The breach rate in this specific cohort was 7.8%. A total of 765 PSs were placed into the L3\u2013S1 levels in this study; 546 (71%) of these screws were \u2265 7.5 mm in diameter. No statistical difference in breach rate was noted in PSs placed through revision spinal levels versus nonrevision spinal levels (p = 0.499). Additionally, no increase in breach rate was noted with placement of 7.5-mm-diameter screws.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Three-dimensional image guidance is a useful adjunct to placement of spinal instrumentation. The complication rate in this study was low, and accurate placement of instrumentation was achieved despite the high percentage of revision surgery cases in our patient population. Additionally, because active fluoroscopy was not used for instrumentation placement, there was minimal to no radiation exposure to the surgeon or operating room staff.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2008.10.spi08383","type":"journal-article","created":{"date-parts":[[2009,1,2]],"date-time":"2009-01-02T15:52:36Z","timestamp":1230911556000},"page":"33-39","source":"Crossref","is-referenced-by-count":126,"title":["Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort"],"prefix":"10.3171","volume":"10","author":[{"given":"Eric W.","family":"Nottmeier","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Will","family":"Seemer","sequence":"additional","affiliation":[{"name":"Department of Chemistry, University of North Florida, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip M.","family":"Young","sequence":"additional","affiliation":[{"name":"Radiology, Mayo Clinic; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0010033","series-title":"Spine","doi-asserted-by":"publisher","first-page":"2160","DOI":"10.1097\/00007632-200110010-00024","article-title":"Transpedicular screw placement: image-guided versus lateralview fluoroscopy: in vitro simulation","volume":"26","author":"Assaker","year":"2001"},{"key":"b2-0010033","series-title":"Spine","doi-asserted-by":"publisher","first-page":"2503","DOI":"10.1097\/00007632-200211150-00015","article-title":"Image-guided spine surgery: a cadaver study comparing conventional open laminoforaminotomy and two image-guided techniques for pedicle screw placement in posterolateral fusion and nonfusion models","volume":"27","author":"Austin","year":"2002"},{"key":"b3-0010033","series-title":"J Neurosurg","first-page":"74","article-title":"Effect of frameless stereotaxy on the accuracy of C1\u20132 transarticular screw placement","volume":"95","author":"Bloch","year":"2001"},{"key":"b4-0010033","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1007\/s00586-005-1024-1","article-title":"A preliminary study of reliability of impedance measurement to detect iatrogenic initial pedicle perforation (in the porcine model)","volume":"15","author":"Bolger","year":"2006"},{"key":"b5-0010033","series-title":"Spine","doi-asserted-by":"publisher","first-page":"S184","DOI":"10.1097\/00007632-199206001-00021","article-title":"Complications of lumbar spinal fusion with transpedicular instrumentation","volume":"17","author":"Davne","year":"1992"},{"key":"b6-0010033","series-title":"Aust Orthop Assoc Bull","first-page":"18","article-title":"Preliminary report on thyroid cancer survey","volume":"38","author":"Dewey","year":"1997"},{"key":"b7-0010033","series-title":"Spine","doi-asserted-by":"publisher","first-page":"2231","DOI":"10.1097\/00007632-199311000-00015","article-title":"Complications associated with the technique of pedicle screw fixation. 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