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Updated: May 13, 2026
Optimizing Minimally Invasive Spine Surgery: A Fully 3D CT O-Arm Navigated Workflow in MIS TLIF
Published on: October 17, 2025
CT-3D-fluoroscopy matching navigation can reduce the malposition rate of iliosacral screw insertion for
Masaki Takao1, Takashi Nishii, Takashi Sakai
1Departments of *Orthopaedic Surgery, and †Orthopaedic Medical Engineering, Graduate School of Medicine, Osaka University, Osaka, Japan.
Objectives:
The aim of the present study was to determine whether 3-dimensional (3D) fluoroscopic navigation combined with a preoperative computer tomography (CT)-based plan could enable surgeons to perform safe and reliable iliosacral screw insertion despite their limited experience.
Methods:
Eight pelvises with surrounding soft tissue donated from embalmed cadavers were used. Kirschner wires with a diameter of 3 mm were placed across the ilia bilaterally into the S1 and S2 vertebrae by 4 orthopaedic trainees. In 4 specimens, wires were placed across the right ilium using conventional technique and the left ilium using the CT-3D-fluoroscopy matching navigation system. In 4 other specimens, wires were placed across the right ilium using the 3D-fluoroscopic navigation system and the left ilium using the CT-3D-fluoroscopy matching navigation system. A postoperative CT-based analysis of wire localization was performed. The number of wire insertions until the final position check, operation duration, and radiation time and dose were also evaluated.
Results:
The percentage of wires inserted correctly was higher in the CT-3D-fluoroscopy matching navigated group (100%) than in the conventional technique group (50%) and 3D-fluoroscopic navigation group (50%). The number of wire insertions and radiation time were significantly lower with both navigation systems than with the conventional technique, whereas there was no significant difference between the navigation systems. There were no significant differences in operation time and radiation dose among the 3 groups.
Conclusions:
The CT-3D-fluoroscopy matching navigation system reduced the malposition rate of percutaneous iliosacral screw insertion when performed by less experienced surgeons.
