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Related Experiment Video

Updated: Mar 13, 2026

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Spinal intraoperative three-dimensional navigation: correlation between clinical and absolute engineering accuracy.

Daipayan Guha1, Raphael Jakubovic2, Shaurya Gupta3

  • 1Division of Neurosurgery, Department of Surgery, University of Toronto, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Institute of Medical Science, School of Graduate Studies, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.

The Spine Journal : Official Journal of the North American Spine Society
|October 26, 2016
PubMed
Summary
This summary is machine-generated.

Computer-assisted navigation (CAN) for spinal pedicle screw placement showed no correlation between clinical accuracy and absolute navigation accuracy. Surgeons may compensate for navigation errors, suggesting standardized reporting of quantitative metrics is needed.

Keywords:
Frameless stereotaxyImage guidanceIntraoperative navigationPedicle screwRegistrationTarget registration error

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Area of Science:

  • Spine surgery
  • Medical imaging
  • Surgical navigation

Background:

  • Spinal computer-assisted navigation (CAN) is used for pedicle screw placement, with reported reductions in screw breach rates.
  • However, screw breach definitions vary, and absolute quantitative error is a more precise metric for navigation accuracy.
  • This metric is inconsistently reported in clinical studies of CAN-guided screw accuracy.

Purpose of the Study:

  • To determine the correlation between clinical pedicle screw accuracy (postoperative imaging) and absolute quantitative navigation accuracy.
  • To evaluate the reliability of different clinical screw accuracy classifications.

Main Methods:

  • Retrospective review of 209 pedicle screws placed with intraoperative 3D CAN in 30 patients undergoing spinal fusion.
  • Clinical screw accuracy was assessed using Heary and 2 mm classifications by multiple raters.
  • Absolute navigation accuracy was quantified by translational and angular error in axial and sagittal planes.

Main Results:

  • Acceptable screw accuracy was lower with the 2 mm grade (92.6%) compared to the Heary grade (95.1%), especially in the lumbar spine.
  • Inter-rater reliability was good for Heary and moderate for 2 mm, with higher agreement among radiologists than surgeons.
  • No significant correlation was found between clinical screw grade and absolute navigation accuracy.

Conclusions:

  • Radiographic classifications for pedicle screw accuracy have variable sensitivity and inter-rater reliability.
  • The poor correlation between clinical and absolute navigation accuracy suggests surgeons may compensate for registration errors.
  • Future studies should report absolute translational and angular errors; clinical grades may be more reliable when assessed by multiple radiologists.