Transpedicular Screw Placement Accuracy Using the O-Arm Versus Freehand Technique at a Single Institution

Area of Science:

• Spinal surgery
• Orthopedic surgery
• Medical imaging

Background:

• Pedicle screw placement is crucial for spinal fusion success.
• Intraoperative imaging tools aim to improve surgical accuracy.
• The O-arm with navigation is one such tool evaluated for pedicle screw placement.

Purpose of the Study:

• To compare the accuracy of pedicle screw placement using the O-arm with navigation versus the freehand technique.
• To assess the effectiveness of the O-arm as an intraoperative imaging tool for spinal surgery.

Main Methods:

• Retrospective cohort study.
• Analysis of 1161 pedicle screws (454 O-arm, 707 freehand) across cervical, thoracic, and lumbar spine levels.
• Classification of pedicle breaches and statistical comparison between the O-arm and freehand groups.

Main Results:

• Overall pedicle breach rate was 12.1% for the O-arm group and 12.6% for the freehand group (P = .811).
• No significant difference in accuracy or revision rates between the O-arm and freehand techniques.
• Lateral pedicle breach was the most common type in both groups without significant difference.

Conclusions:

• The O-arm coupled with navigation does not guarantee improved accuracy for transpedicular screw placement compared to the freehand technique.
• Current evidence suggests no significant benefit of the O-arm for pedicle screw accuracy in this cohort.
• Further research may explore specific applications or improved navigation protocols.