Pedicle Screw Insertion Accuracy Using O-Arm, Robotic Guidance, or Freehand Technique: A Comparative Study

Area of Science:

• Spine surgery
• Surgical navigation technologies
• Radiological imaging

Background:

• Pedicle screw insertion is crucial for spinal stabilization.
• O-Arm navigation and robotic assistance are increasingly used for pedicle screw placement.
• Direct comparisons between these advanced techniques and traditional methods are limited.

Purpose of the Study:

• To compare the accuracy of pedicle screw insertion using O-Arm navigation, robotic assistance, and freehand fluoroscopic techniques.
• To evaluate the impact of different navigation methods on screw placement precision.

Main Methods:

• Retrospective analysis of 569 pedicle screws implanted in 84 patients.
• Screws were placed using robotic assistance (11 patients), O-arm navigation (25 patients), or freehand fluoroscopy (48 patients).
• Screw accuracy was assessed postoperatively using CT scans based on Rampersaud criteria by two independent observers.

Main Results:

• No statistically significant difference in screw accuracy was found between the three groups.
• Completely intrapedicular screw placement (Grade A) rates were: 78.8% (robotic), 69.6% (O-arm), and 70.4% (freehand).
• Misplacement rates (Grades C&D) were low and similar across groups (4.7% robotic, 4.2% O-arm, 6.4% freehand).

Conclusions:

• Current advanced navigation technologies do not significantly alter pedicle screw insertion accuracy in this study's context.
• Spinal fellows demonstrated comparable accuracy to experienced surgeons when using these techniques under supervision.
• Further research is needed to assess other potential benefits (e.g., radiation exposure, efficiency) of newer technologies.