Variability Analysis of Manual and Computer-Assisted Preoperative Thoracic Pedicle Screw Placement Planning

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Study Design.A comparison among preoperative pedicle screw placement plans, obtained from computed tomography (CT) images manually by two spine surgeons and automatically by a computer-assisted method.Objective.To analyze and compare the manual and computer-assisted approach to pedicle screw placement planning in terms of the inter- and intraobserver variability.Summary of Background Data.Several methods for computer-assisted pedicle screw placement planning have been proposed; however, a systematic variability analysis against manual planning has not been performed yet.Methods.For 256 pedicle screws, preoperative placement plans were determined manually by two experienced spine surgeons, each independently performing two sets of measurements by using a dedicated software for surgery planning. For the same 256 pedicle screws, preoperative placement plans were also obtained automatically by a computer-assisted method that was based on modeling of the vertebral structures in 3D, which were used to determine the pedicle screw size and insertion trajectory by maximizing its fastening strength through the underlying bone mineral density.Results.A total of 1024 manually (2 observers × 2 sets × 256 screws) and 256 automatically (1 computer-assisted method × 256 screws) determined preoperative pedicle screw placement plans were obtained and compared in terms of the inter- and intraobserver variability. A large difference was observed for the pedicle screw sagittal inclination that was, in terms of the mean absolute difference and the corresponding standard deviation, equal to 18.3° ± 7.6° and 12.3° ± 6.5°, respectively for the intraobserver variability of the second observer and for the interobserver variability between the first observer and the computer-assisted method.Conclusion.The interobserver variability among the observers and the computer-assisted method is within the intraobserver variability of each observer, which indicates on the potential use of the computer-assisted approach as a useful tool for spine surgery that can be adapted according to the preferences of the surgeon.Level of Evidence: 3

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