Navigated odontoid screw placement using the O-arm: technical note and case series.

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Odontoid process fractures are increasing in the aging population.
• Anterior screw fixation is a treatment option for these fractures.
• 3D image guidance may enhance safety in posterior cervical procedures, but its utility in anterior approaches is less explored.

Purpose of the Study:

• To present a stepwise technique for anterior odontoid screw placement using the Medtronic O-arm navigation system.
• To describe the initial institutional experience with this navigated surgical approach.
• To compare outcomes between navigated and non-navigated odontoid screw fixation.

Main Methods:

• Retrospective review of anterior odontoid screw fixation for Type II fractures (2006-2015).
• Development of a standardized protocol for navigated odontoid screw placement.
• Comparison of navigated versus non-navigated cases regarding complications, operative time, blood loss, and union rates.

Main Results:

• Ten patients underwent odontoid screw placement; 8 used O-arm navigation.
• Two navigated cases had complications (hematoma, screw retraction) requiring re-operation.
• One non-navigated case had vocal cord paralysis; radiographic nonunion occurred in one patient per group.

Conclusions:

• The authors provide a detailed technique for navigated odontoid screw placement.
• O-arm-assisted odontoid screw fixation appears to be a viable surgical approach.
• Further research is needed to compare the accuracy and efficiency of navigated versus non-navigated techniques.