| Objective: To compare the accuracy and operating features between ISO C (3D) and CT-based navigation system in the lumbar pedicle punctures. And on this basis, To describe a minimally invasive translaminar facet screw fixation technique that was modified from the Magerl method, and to assess its technical feasibility.Methods/design: According the operating requirements, three cadaveric lumbar trunks were selected for the lumbar pedicle punctures from L1 to L5 under the guidance of the ISO C (3D) and CT-based navigation systems. In the procedure, a C-arm fluoroscopy was used to monitor the accuracy of the puncture. The time of installing the frames, taking pictures by ISO C (3D) X-ray machine and finishing every screw was recorded. After the experiment, the operating features, advantages and shortcomings of the two systems was analyzed.And then, three cadaveric lumbar trunks were selected for percutaneous translaminar facet screw fixation assisted by ISO C (3D) navigation system. In the procedure, a C-arm fluoroscopy was used to monitor the accuracy of the puncture. The time of installing the frames, taking pictures by ISO C (3D) X-ray machine and finishing every screw was recorded. After the experiment, anteroposterior and lateral views and 3-dimensional scanning were taken to show trajectories of the screws.Results: A total of 30 pedicles punctures were done from L1 to L5 by ISO C (3D) navigation and CT based navigation. Only 2 punctures missed under the guidance of the CT-based navigation systems. Taking intraoperative pictures by ISO C (3D) X-ray machine needed 5 minutes (4-6 minutes), while CT based navigation needs preoperative CT scan. Every registration for CT based navigation took about 12±4 minutes. Both navigation systems had excellent accuracy in the guidance of the lumbar pedicle punctures, and had different operating features.And a total of 30 percutaneous translaminar facet screws were inserted, the average time of installing the frame was about 4 minutes (3-5 minutes), and taking pictures by ISO C (3D) X-ray machine needed 5 minutes (4-6 minutes), finishing every screw took about 8 minutes (5-12 minutes). ISO C (3D) navigation views were not significantly different from fluoroscopic images. 3 screws violated the inner laminae walls.Conclusion: Both navigation systems had its special advantages. CT based navigation system had clearer pictures, especially for the osteoprotic vertebral bodies, and it had less requirements for the equipments. The operating process of ISO C (3D) navigation system was more convenient and rapid, and suitable for percutaneous vertebral puncture, and percutaneous translaminar facet screw fixation assisted by ISO C (3D) navigation system is technically feasible. It seems that the ISO C (3D) navigation system assisted percutaneous translaminar facet pedicle screw fixation is a useful, minimally invasive method.
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