• Masayuki Shimizu, Jun Takahashi, Shota Ikegami, Shugo Kuraishi, Toshimasa Futatsugi, and Hiroyuki Kato.
• Department of Orthopedic Surgery, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan, masasimi@shinshu-u.ac.jp.
• Eur Spine J. 2014 Oct 1; 23 (10): 2211-7.

PurposeWe developed a new multilevel registration technique for pedicle screw (PS) insertion that has the capability of registering three consecutive vertebrae simultaneously, using a reference frame set to one of the caudal vertebrae. PSs are inserted in the consecutive and adjacent one or two vertebrae. This study aimed to investigate the perforation rates of the registered and unregistered adjacent vertebrae and compare the perforation rate of the PS and insertion time per PS between the conventional and new techniques.MethodsSixty-nine consecutive scoliosis patients who underwent PS insertion using multilevel registration were enrolled. The conventional and new techniques were used in 29 subjects, and in 40 subjects, respectively. The total numbers of PSs used were 375 and 492, respectively. Of the 492 PSs, 301 were inserted to the registered vertebrae and 191 were inserted to the unregistered adjacent vertebrae. The PS malposition on postoperative axial computed tomography was classified as grades 2 and 3 perforation, using the Rao classification. The perforation rate and insertion time per PS were compared between the conventional and new techniques.ResultsThe perforation rates did not significantly differ between the registered and unregistered vertebrae (10.3 vs. 6.3 %,), and between the new and conventional techniques (8.7 vs. 9.6 %). The insertion time per PS was significantly shorter in the new technique than in the conventional technique (3.9 ± 1.0 vs. 4.9 ± 1.3 min; p < 0.001).ConclusionsThe new technique may be less invasive and decrease operative time without compromising the accuracy of PS placement.

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