Related Experiment Video
Updated: Aug 18, 2026
Pedicle Screw Placement Using an Augmented Reality Head-Mounted Display in a Porcine Model
Published on: May 24, 2024
Clinical accuracy of fluoroscopic computer-assisted pedicle screw fixation: a CT analysis
Y Raja Rampersaud1, Justin H T Pik, David Salonen
1Division of Orthopaedic, University of Toronto, Toronto, Ontario, Canada. raja.rampersaud@uhn.on.ca
Study Design:
Observational cohort study with computerized tomography (CT) analysis of in vivo pedicle screw placement.
Objective:
To evaluate the clinical accuracy of computer-assisted fluoroscopy for the placement of thoracic and lumbosacral (LS) pedicle screws.
Summary Of Background Data:
Computer-assisted fluoroscopy is an adjunct for the placement of pedicle screws.
Methods:
Postoperative CT of 360 titanium pedicle screws (281 LS [L1-S1]; 79 thoracic [T2-T12]) were independently assessed. All screws were placed using the FluoroNav system (Medtronic Surgical Navigation Technologies, Louisville, CO). The relative position of the screw to the pedicle was graded as follows: A = completely in; B = <2 mm breach; C = 2-4 mm breach; and D = >4 mm breach. If an osseous breach occurred, the direction of the breach was further classified.
Results:
Eight-five percent of screws were completely contained within the pedicle. Fifty-five-pedicle breaches (25 medial; 30 lateral) occurred. Pedicle breaches were graded B in 13.1% (47 breaches), C in 1.9% (7), and D in 0.3% (1) of screws. Pedicle breach was significantly higher in the thoracic compared to the LS spine, 31.6% (25/79) and 10.6% (30/281), respectively (P < 0.0001). In the thoracic spine, 72% of pedicle breaches were lateral. In 49% of breaches, the screw diameter was larger than the pedicle diameter. None of the pedicle breaches were associated with neurologic or other clinical sequelae.
Conclusions:
The clinical pedicle breach rate in this study is comparable to those reported using conventional techniques with or without fluoroscopic assistance. FluoroNav appears to be a safe adjunct for the placement of thoracic and LS pedicle screws.
