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Updated: Oct 8, 2025
A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement
Published on: May 11, 2020
Benefits and Pitfalls of O-Arm Navigation in Cervical Pedicle Screw
Hong Kyung Shin1, Sang Ryong Jeon1, Sung Woo Roh1
1Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Background:
Cervical pedicle screw (CPS) with O-arm-based intraoperative navigation has demonstrated satisfactory results in recent studies. In this article, we introduce our experience and discuss important considerations for CPS placement with O-arm navigation.
Methods:
We retrospectively reviewed the data of 51 patients with 156 pedicle screws who underwent O-arm navigated CPS from July 2020 to October 2021. The accuracy of each screw placement was evaluated at the initial screw location using intraoperative 3D reconstructed O-arm images and the final screw location using postoperative computed tomography (CT). The screw accuracy was assessed in the axial image.
Results:
The initial accuracy of screws on intraoperative 3D reconstructed O-arm images was 93.6% (146 of 156). The accuracies of the mid-cervical level (C3, C4, C5) were relatively low (83.3%-85.0%) compared with those of C2, C6, and C7 (93.3%-100.0%) at the initial screw due to the rotation of the vertebral body. Among 10 violated screws, 5 were converted to lateral mass screws or removed intraoperatively, and the other 5 were retained because the violations were minimal. After converting the screw, the final accuracy of the screws in postoperative CT was 96.7% (146 of 151).
Conclusions:
CPS with O-arm navigation showed relatively low accuracy at the mid-cervical level due to vertebral rotation. However, the opportunity to convert the screw from intraoperative 3D reconstructed O-arm images is the advantage of the O-arm navigation, and it showed excellent accuracy.
