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Medtronic","award":["70295"],"award-info":[{"award-number":["70295"]}]},{"name":"Finnish State Funding, Medtronic","award":["70304"],"award-info":[{"award-number":["70304"]}]},{"name":"Stryker","award":["ERP-2020-12238"],"award-info":[{"award-number":["ERP-2020-12238"]}]},{"name":"Stryker","award":["S-I-027"],"award-info":[{"award-number":["S-I-027"]}]},{"name":"Stryker","award":["70295"],"award-info":[{"award-number":["70295"]}]},{"name":"Stryker","award":["70304"],"award-info":[{"award-number":["70304"]}]},{"name":"Nuvasive","award":["ERP-2020-12238"],"award-info":[{"award-number":["ERP-2020-12238"]}]},{"name":"Nuvasive","award":["S-I-027"],"award-info":[{"award-number":["S-I-027"]}]},{"name":"Nuvasive","award":["70295"],"award-info":[{"award-number":["70295"]}]},{"name":"Nuvasive","award":["70304"],"award-info":[{"award-number":["70304"]}]},{"name":"Cerapedics","award":["ERP-2020-12238"],"award-info":[{"award-number":["ERP-2020-12238"]}]},{"name":"Cerapedics","award":["S-I-027"],"award-info":[{"award-number":["S-I-027"]}]},{"name":"Cerapedics","award":["70295"],"award-info":[{"award-number":["70295"]}]},{"name":"Cerapedics","award":["70304"],"award-info":[{"award-number":["70304"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Widely used surgical treatment for adolescent idiopathic scoliosis (AIS) is posterior spinal fusion using pedicle screw instrumentation (PSI). Two-dimensional (2D) or three-dimensional (3D) navigation is used to track the screw positioning during surgery. In this study, we evaluated the screw misplacement, complications, and need for reoperations of intraoperative 3D as compared to 2D imaging in AIS patients. There were 198 adolescents, of which 101 (51%) were evaluated with 2D imaging and 97 (49%) with 3D imaging. Outcome parameters included radiographic correction, health-related quality of life (HRQOL), complications, and reoperations. The mean age was 15.5 (SD 2.1) years at the time of the surgery. Forty-four (45%) patients in the 3D group and 13 (13%) patients in the 2D group had at least one pedicle screw repositioned in the index operation (p &lt; 0.001). Six (6%) patients in the 2D group, and none in the 3D group had a neurological complication (p = 0.015). Five (5%) patients in the 2D group and none in the 3D group required reoperation (p = 0.009). There were no significant differences in HRQOL score at two-year follow-up between the groups. In conclusion, intraoperative 3D imaging reduced pedicle screw-related complications and reoperations in AIS patients undergoing PSI as compared with 2D imaging.<\/jats:p>","DOI":"10.3390\/children9081129","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T20:49:28Z","timestamp":1659041368000},"page":"1129","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Intraoperative 3D Imaging Reduces Pedicle Screw Related Complications and Reoperations in Adolescents Undergoing Posterior Spinal Fusion for Idiopathic Scoliosis: A Retrospective Study"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2742-8491","authenticated-orcid":false,"given":"Antti J.","family":"Saarinen","sequence":"first","affiliation":[{"name":"Department of Pediatric Orthopedic Surgery, Turku University Hospital, 20521 Turku, Finland"},{"name":"Department of Orthopedics and Traumatology, Helsinki University Hospital, 00260 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eetu N.","family":"Suominen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedic Surgery, Turku University Hospital, 20521 Turku, Finland"},{"name":"Department of Orthopedics and Traumatology, Helsinki University Hospital, 00260 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Helenius","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Turku University Hospital, 20521 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6275-5140","authenticated-orcid":false,"given":"Johanna","family":"Syv\u00e4nen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedic Surgery, Turku University Hospital, 20521 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9114-2204","authenticated-orcid":false,"given":"Arimatias","family":"Raitio","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedic Surgery, Turku University Hospital, 20521 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5200-3279","authenticated-orcid":false,"given":"Ilkka","family":"Helenius","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Helsinki University Hospital, 00260 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/S0140-6736(08)60658-3","article-title":"Adolescent Idiopathic 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Scoliosis","volume":"29","author":"Kim","year":"2004","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.2106\/JBJS.18.01370","article-title":"Back Pain and Quality of Life After Surgical Treatment for Adolescent Idiopathic Scoliosis at 5-Year Follow-up: Comparison with Healthy Controls and Patients with Untreated Idiopathic Scoliosis","volume":"101","author":"Helenius","year":"2019","journal-title":"JBJS"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E465","DOI":"10.1097\/BRS.0b013e3181d1021a","article-title":"Complications of Pedicle Screw Fixation in Scoliosis Surgery: A Systematic Review","volume":"35","author":"Hicks","year":"2010","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1097\/00007632-200109150-00022","article-title":"Thoracic Pedicle Screw Fixation in Spinal Deformities: Are They Really Safe?","volume":"26","author":"Suk","year":"2001","journal-title":"Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E639","DOI":"10.1097\/BRS.0000000000002465","article-title":"Implant Density at the Apex Is More Important Than Overall Implant Density for 3D Correction in Thoracic Adolescent Idiopathic Scoliosis Using Rod Derotation and En Bloc Vertebral Derotation Technique","volume":"43","author":"Delikaris","year":"2018","journal-title":"Spine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1302\/0301-620X.102B3.BJJ-2019-1499.R1","article-title":"Ten Techniques for Improving Navigated Spinal Surgery","volume":"102-B","author":"Cawley","year":"2020","journal-title":"Bone Jt. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"E119","DOI":"10.1097\/BRS.0b013e3182257cae","article-title":"The Accuracy of Intraoperative O-Arm Images for the Assessment of Pedicle Screw Postion","volume":"37","author":"Santos","year":"2012","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E188","DOI":"10.1097\/BRS.0b013e31822a2e0a","article-title":"Pediatric Pedicle Screw Placement Using Intraoperative Computed Tomography and 3-Dimensional Image-Guided Navigation","volume":"37","author":"Larson","year":"2012","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1016\/j.jocn.2012.01.020","article-title":"Intra-Operative Cone-Beam CT (O-Arm) and Stereotactic Navigation in Acute Spinal Trauma Surgery","volume":"19","author":"Schouten","year":"2012","journal-title":"J. Clin. Neurosci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1007\/s00586-015-4012-0","article-title":"Does Intraoperative Navigation Improve the Accuracy of Pedicle Screw Placement in the Apical Region of Dystrophic Scoliosis Secondary to Neurofibromatosis Type I: Comparison between O-Arm Navigation and Free-Hand Technique","volume":"25","author":"Jin","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/01.brs.0000150482.26918.d8","article-title":"Accuracy and Efficacy of Thoracic Pedicle Screws in Curves More Than 90\u00b0","volume":"30","author":"Kuklo","year":"2005","journal-title":"Spine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1097\/00007632-199907150-00008","article-title":"Results of the Scoliosis Research Society Instrument for Evaluation of Surgical Outcome in Adolescent Idiopathic Scoliosis: A Multicenter Study of 244 Patients","volume":"24","author":"Haher","year":"1999","journal-title":"Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.jspd.2018.11.012","article-title":"Intraoperative Computed Tomography\u2013Guided Navigation for Pediatric Spine Patients Reduced Return to Operating Room for Screw Malposition Compared With Freehand\/Fluoroscopic Techniques","volume":"7","author":"Baky","year":"2019","journal-title":"Spine Deform."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E473","DOI":"10.1097\/BRS.0b013e318238bbd9","article-title":"Computed Tomography\u2013Guided Navigation of Thoracic Pedicle Screws for Adolescent Idiopathic Scoliosis Results in More Accurate Placement and Less Screw Removal","volume":"37","author":"Ughwanogho","year":"2012","journal-title":"Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.1016\/j.wneu.2017.09.091","article-title":"Revision Rate of Misplaced Pedicle Screws of the Thoracolumbar Spine\u2013Comparison of Three-Dimensional Fluoroscopy Navigation with Freehand Placement: A Systematic Analysis and Review of the Literature","volume":"109","author":"Fichtner","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1007\/s00402-008-0807-3","article-title":"Usefulness of a Navigation System in Surgery for Scoliosis: Segmental Pedicle Screw Fixation in the Treatment","volume":"129","author":"Nakanishi","year":"2009","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1007\/s00264-019-04470-3","article-title":"O-Arm Navigation versus C-Arm Guidance for Pedicle Screw Placement in Spine Surgery: A Systematic Review and Meta-Analysis","volume":"44","author":"Feng","year":"2020","journal-title":"Int. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/01.BRS.0000109983.12113.9B","article-title":"Free Hand Pedicle Screw Placement in the Thoracic Spine: Is It Safe?","volume":"29","author":"Kim","year":"2004","journal-title":"Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s00590-018-2130-1","article-title":"Intraoperative Radiation Exposure in Spinal Scoliosis Surgery for Pediatric Patients Using the O-Arm\u00ae Imaging System","volume":"28","author":"Kobayashi","year":"2018","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s00586-008-0639-4","article-title":"Placement of Pedicle Screws in Thoracic Idiopathic Scoliosis: A Magnetic Resonance Imaging Analysis of Screw Placement Relative to Structures at Risk","volume":"17","author":"Tosun","year":"2008","journal-title":"Eur. Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/BRS.0000000000001738","article-title":"Accuracy and Safety of Pedicle Screw Placement in Adolescent Idiopathic Scoliosis Patients: A Review of 2020 Screws Using Computed Tomography Assessment","volume":"42","author":"Kwan","year":"2017","journal-title":"Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s00586-008-0715-9","article-title":"Delayed Perforation of the Aorta by a Thoracic Pedicle Screw","volume":"17","author":"Wegener","year":"2008","journal-title":"Eur. Spine J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e415","DOI":"10.1097\/BPO.0000000000001008","article-title":"Delayed Dural Leak Following Posterior Spinal Fusion for Idiopathic Scoliosis Using All Posterior Pedicle Screw Technique","volume":"37","author":"Floccari","year":"2017","journal-title":"J. Pediatr. Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s00586-019-06005-1","article-title":"Delayed Presentation of Infected Common Iliac Artery Pseudoaneurysm Caused by Malpositioned Pedicle Screw after Minimally Invasive Scoliosis Surgery","volume":"28","author":"Suh","year":"2019","journal-title":"Eur. Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s43390-021-00434-z","article-title":"0.4% Incidence of Return to OR Due to Screw Malposition in a Large Prospective Adolescent Idiopathic Scoliosis Database","volume":"10","author":"Swany","year":"2022","journal-title":"Spine Deform."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1016\/j.spinee.2017.04.001","article-title":"Intraoperative Image Guidance Compared with Free-Hand Methods in Adolescent Idiopathic Scoliosis Posterior Spinal Surgery: A Systematic Review on Screw-Related Complications and Breach Rates","volume":"17","author":"Chan","year":"2017","journal-title":"Spine J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/BRS.0000000000000127","article-title":"Using the Freehand Pedicle Screw Placement Technique in Adolescent Idiopathic Scoliosis Surgery: What Is the Incidence of Neurological Symptoms Secondary to Misplaced Screws?","volume":"39","author":"Dede","year":"2014","journal-title":"Spine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/s00586-008-0681-2","article-title":"Intracranial Hypotension Following Scoliosis Surgery: Dural Penetration of a Thoracic Pedicle Screw","volume":"17","author":"Albayram","year":"2008","journal-title":"Eur. Spine J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ijsp.2011.11.002","article-title":"Intraoperative 3-Dimensional Imaging (O-Arm) for Assessment of Pedicle Screw Position: Does It Prevent Unacceptable Screw Placement?","volume":"6","author":"Sembrano","year":"2012","journal-title":"Int. J. Spine Surg."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/8\/1129\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:58:33Z","timestamp":1760140713000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/8\/1129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,28]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["children9081129"],"URL":"https:\/\/doi.org\/10.3390\/children9081129","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,28]]}}}