TY - JOUR AU - GarcĂ­a-Fantini, Manuel AU - De Casas, Ricardo PY - 2018 TI - Three-dimensional fluoroscopic navigation versus fluoroscopy-guided placement of pedicle screws in L4-L5-S1 fixation: single-centre experience of pedicular accuracy and S1 cortical fixation of 810 screws JF - Journal of Spine Surgery; Vol 4, No 4 (December 2018): Journal of Spine Surgery Y2 - 2018 KW - N2 - Background: Three-dimensional (3D) navigation techniques can theoretically provide higher accuracy rates and increased safety for pedicle screw (PS) placement than traditional fluoroscopy (FL) guided methods. In this study, we compare the pedicular accuracy of 3D isocentric fluoroscopic navigation (3DFL) versus FL guidance in PS L4-L5-S1 fixation and evaluate the differential cortical purchase and safety of fixation of the S1 PS. Methods: This is a single-centre retrospective study of 810 PSs placed in open L4-L5-S1 fixation between 2012 and 2017 in 39 patients using standard FL and in 96 patients under 3DFL. Pedicular screw accuracy was determined by postoperative computed tomography (CT) and graded on a 4-tiered classification system according to Gertzbein and Robbins. In addition, sacral screws were evaluated depending on the degree of cortical fixation: monocortical, bicortical or tricortical, and the degree of safety with respect to retroperitoneal structures. Results: Grade 0 perfect pedicular screw placement was 95% for 3DFL screws compared to 85% for screws placed under fluoroscopy (P Conclusions: 3DFL enhances the accuracy and safety of PS placement in L4-L5-S1 fixation, reducing the rate of misplaced screws and improving S1 cortical fixation. UR - http://jss.amegroups.com/article/view/4333