In Vitro Simulation

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Abstract
Study Design. Frameless stereotaxy with doppler ultrasound and three dimensional computer model registration is assessed in vitro for pedicle screw placement. Objective. To identify feasibility of pedicle screw navigation and placement using this technology. Summary of Background Data. Inaccurate pedicle screw placement can lead to neurovascular injury or suboptimal fixation. Present techniques in pedicle screw placement involve only confirmation of hole orientation. Method. Forty-four pedicle screws were placed in lumbosacral models and cadaver specimens. Accuracy was assessed with a computed tomography scan and vertebral cross sectioning. Results. All screws were intrapedicular. Accuracy of anterior cortical fixation was 1.5 mm, with a range of 2.5 mm. Conclusion. In vitro frameless stereotaxy is accurate for pedicle screw placement. This technology adds a component of navigation to pedicle screw placement.