1. High accuracy of 2D fluoroscopic based navigation of pedicle screw fixation in the lumbar spine utilizing cylinder pedicle design, innovative technique By
Dr. Salah Al-Akkad, MD, FRCSC, FACS, FAANS, DABNS
Johns Hopkins / Aramco Health Care
Dhahran, Saudi Arabia

2. Research Question
Does 2D fluoroscopic based Navigation of lumbar spine provide sufficient information for
Appropriate guidance to the placement of pedicle screws (safety)
Reliable training tool with consistency

3. Method
Adoption of the cylinder design, and evaluate the margins of radiographic anatomy
cases done percutaneously using tubes techniques or wiltsee approach
Including only instrumentation of L1 to S1
Excluding
tumors
scoliosis
thoracic

4. All cases done with IOM Cases
37 consecutive adult cases with 196 pedicle screws
2trauma,
7 degenerative
28 with spondylolysthesis grade I, II
All cases done with IOM

5. Adoption of the cylinder design, and evaluate the margins of radiographic anatomy using Navigation
Original Design was presented by Professor Richard Assaker 2004 , Dubai

11. Results Misplacement rate was 2.6%, 5 screws
2 screws had cortical encroachment medially (both are L1)
the other 3 had lateral minor breach(<2mm) to the pedicle (all were L4),
None IOM alert
none resulted in neurological symptoms
None needed reoperations

12. Reproducibility for Training
Supervising 3 Navigated workshops
10 sessions, percutaneous, lumbar, navigated tools “tippitap” method , ( controlled, but no tactile sensation)
60 participant ( residents, fellows, registrars, attending's)
18 screws
Using O-Arm for creating 2 D image view with available CT cuts for demonstration,
Verifying results using O-Arm CT scan for 3D evaluation
One minimal breach on radiographic 3D evaluation
No difference the level of training by applying this method.

13. Using 2D fluoroscopic based navigation for the lumbar spine utilizing pedicle cylinder design for targeting lumbar pedicle
Safe
Reliable teaching tool