Multi-slice spiral CT image 3D reconstruction assisting pedicle screw placement in spinal surgery

Objective To study the method of MSCT image three-dimensional (3D) reconstruction technique assisting pedicle screw placement in spinal surgery. Methods Thin-slice volume scan by MSCT was performed in 68 patients with pedicle screw placement in spinal surgery, and then 3D image was reconstructed with VR and MPR techniques. The reconstructed 3D images were then utilized to improve accuracy of diagnosis and individualize measurements to guide spinal surgery and evaluate therapeutic effect. Results Three hundreds and sixty-six posterior pedicle screws were inserted assisting with MSCT image 3D reconstruction technique, including 168 cervical pedicle screws, 52 thoracic pedicle screws and 146 lumbar pedicle screws, respectively. Twenty (5.46%) pedicle perforations, which located out of "definite safe zone" and might potentially cause the complication were determined by postoperative MSCT scan. In 168 cervical pedicle screws placement, 11 pedicle perforations of 1-2 mm were found, and 1 penetrated the lateral cortex 2.2 mm, but with no clinical sequela. One thoracic pedicle screws and 7 lumbar pedicle screws penetrated the pedicle cortex 2-4 mm, respectively. No postoperative damage to spinal cord or neurovascular structures related screw misplacement occurred in any cases. Conclusion With MSCT image 3D reconstruction techniques, the individual and quantifiable reference data can be obtained to assistthe spinal surgery of posterior pedicle screw placement. Based on these techniques, more reasonible preoperative plans can be designed and performed, and the safety and accuracy of the surgery can be improved.