Effect of In-Out-In pedicle screw technique assisted by O-arm navigation system in congenital scoliosis correction
Objective To observe the effect and safety of internal fixation of narrow and variant pedicle using the lateral In-Out-In pedicle screw technique with the assistance of the O-arm navigation system in patients with congenital scoliosis.Methods Seventeen patients with congenital scoliosis underwent correction surgery in Luohe Central Hospital from January,2019 to January,2021,and their clinical data were retrospectively analyzed.During the procedure,with the assistance of O-arm navigation system,the screws were obliquely inserted into the narrow and variant pedicle along the lateral side using In-Out-In technique,or into the normal pedicle for internal fixation to correct lateral and posterior convex deformities.After screw placement,the accuracy of screw placement was evaluated using the O-arm machine scan.After satisfactory correction,residual gaps between vertebral bodies were filled with bone grafts,and the surfaces of transverse processes and other posterior structures within the fusion range were decorticated before bone grafting.The intraoperative details and the success of screw placement in one attempt were recorded.A follow-up was conducted till December,2023,to record the occurrences of postoperative complications such as spinal cord injury,cerebrospinal fluid leakage,incision infection,screw and rod loosening or displacement,and fractures.The full-length anteroposterior and lateral X-rays of the spine were obtained 1 week and 1 year postoperatively to record Cobb angles of lateral and posterior convexities,and to calculate the correction rate.The Scoliosis Research Society-22(SRS-22)scores were compared before operation,and 1 week and 1 year postoperatively.At the latest follow-up,the bone fusion status was evaluated using the Eck fusion grading system.Results(1)The operation lasted for(184.0±43.2)min averagely,with an intraoperative blood loss of(632.0±192.7)mL.The highest instrumented vertebrae was T5,and the lowest one was S1.Totally 9.0±2.7 segments were fixed and fused,and 216 pedicle screws were inserted,including 152 pedicle screws and 64 lateral pedicle screws by using In-Out-In pedicle screw technique,all of which were successfully placed in one attempt.Intraoperative O-arm scans revealed that all screws were positioned close to the inner wall of the pedicles and did not breach the vertebral canal.(2)Follow-up was conducted until December,2023,with a mean follow-up duration of(28.0±3.4)months.No complications as spinal cord injury,cerebrospinal fluid leakage,incision infection,and screw or rod loosening,displacement or fracture developed in 17 patients.In 17 patients,the preoperative Cobb angles for lateral convexity and for posterior convexity were larger before operation[(57.8±6.6)°,(44.0±9.6)°]than those 1 week postoperatively[(12.6±4.2)°,(15.3±2.4)°]and 1 year postoperatively[(15.3±2.4)°,(15.4±2.3)°](P＜0.05),and showed no significant differences 1 week postoperatively compared with those 1 year postoperatively(P＞0.05).The correction rates for lateral convexity and for posterior convexity showed no significant differences 1 week postoperatively[(77.6±8.6)％,(63.9±8.4)％]compared with those 1 year postoperatively[(76.8±7.1)％,(63.6±8.6)％](t=0.272,P=0.789;t=0.123,P=0.904).The SRS-22 score was lower before operation(71.8±4.2)than that 1 week postoperatively(83.1±4.4)and 1 year postoperatively(84.7±3.8)(P＜0.05),and showed no significant difference 1 week postoperatively compared with that 1 year postoperatively(P＞0.05).At the latest follow-up,all 17 patients achieved grade Ⅰ fusion.Conclusion To insert the screws obliquely into the narrow and variant pedicle along the lateral side using In-Out-In pedicle screw technique in congenital scoliosis correction with assistance of O-arm navigation system provides solid internal fixation,good orthopedic effect,and fewer complications.
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