INTRODUCTION: The surgical correction of adult scoliotic disease using transpedicular screws poses a significant challenge for the neurosurgeon. Inherent changes in spinal anatomy, including vertebral rotational components, pedicular hypoplasia, and associated comorbidities such as osteoporosis, present significant risks for trans- and postoperative complications. In order to reduce surgical risks associated with suboptimal transpedicular screw trajectories, including cerebrospinal fluid leakage, vascular, visceral, or neurological injury, technological advancements have emerged to enhance safety during the surgical procedure. The advent of intraoperative imaging acquisition, real-time three-dimensional reconstruction, and assistance in the placement of surgical hardware, such as neuronavigation and intraoperative tomography (3D CT), is now considered a standard in the care of complex spinal pathologies. This is due to the accuracy it provides in predicting transpedicular trajectories and the final placement of surgical instruments. This study proposes an observational, descriptive study, using a series of cases to describe the correlation between the angles of the pedicular trajectory using neuronavigation (anatomical pedicular axis) and the angles obtained from 3D tomography for each operated patient (transpedicular screw axis). The aim is to evaluate the accuracy of the pedicular trajectory in arthrodesis for correcting adult scoliosis spinal deformities. OBJECTIVES: To describe the accuracy of transpedicular screw trajectories in cases of adult scoliotic disease deformities, in patients treated and surgically intervened at the Hospital Universitario Mayor Méderi, using intraoperative 3D tomography and neuronavigation from 2017 to 2022. METHODS: A total of 26 patients diagnosed with adult scoliotic disease, who underwent surgical correction of spinal deformity using intraoperative tomography and neuronavigation at the Hospital Universitario Mayor Méderi between 2017 and 2022, were included in the study. A total of 273 screws were evaluated in 142 vertebral segments. Due to the nature of the study, no sample size was calculated. Patient characteristics were described using absolute and relative frequencies for categorical variables, and measures of central tendency and dispersion for numerical variables. The pedicular trajectory angles were described using means, standard deviations (SD), and 95% confidence intervals. The values were presented overall and stratified by vertebral level. The success rate or accuracy of repositioned screws was calculated in relation to the total number of screws placed per patient. To evaluate the agreement between the pedicular trajectory angles obtained from intraoperative 3D tomography and the predicted pedicular angles from neuronavigation, a mixed linear regression model was adjusted, with the final screw angle as the dependent variable, the angle obtained from neuronavigation as the independent variable, and patient identifiers as random effects terms. Additionally, the difference between the pre-screw implantation angle and the post-screw angle was calculated. These calculations were performed for each TC3D slice (axial and sagittal) and by vertebral level (cervical, thoracic, and lumbosacral). EXPECTED RESULTS: The aim was to study and identify the morphometric parameters of the intervened pedicles and the correlation between the angles of the pedicular axis (neuronavigation) and the final trajectory of the screw (TC3D) in surgical instrumentation for adult scoliosis correction. This allowed for an analysis to determine the accuracy of planned pedicular trajectories and propose angular variations without representing surgical complications.
