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Related Experiment Video

Updated: Jul 24, 2026

A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement

A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement

Published on: May 11, 2020

"Critical pedicle wall" breaches analysis in complex spinal deformity using O-arm navigation.

Ajay Ramesh Kothari¹, Siddharth Manik Katkade¹, Pramod Dashrath Bhilare¹

¹Department of Spine, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.

Surgical Neurology International

|October 9, 2023

Summary

O-arm navigation significantly reduced critical pedicle screw breaches in complex spinal deformity surgery. This advanced imaging technology also minimized operating time, blood loss, and complications.

Keywords:

Complex spinal deformity Critical pedicle wall Minimal complications O-arm navigation Pedicle breach

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Pedicle Screw Placement Using an Augmented Reality Head-Mounted Display in a Porcine Model

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Last Updated: Jul 24, 2026

A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement

A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement

Published on: May 11, 2020

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position

Published on: September 16, 2022

Pedicle Screw Placement Using an Augmented Reality Head-Mounted Display in a Porcine Model

Pedicle Screw Placement Using an Augmented Reality Head-Mounted Display in a Porcine Model

Published on: May 24, 2024

Area of Science:

Spinal surgery
Neurosurgery
Orthopedic surgery

Background:

Free-hand and fluoroscopic-guided pedicle screw placement has high rates of pedicle breaches (15-40%), especially in deformed pedicles.
Medial and inferior pedicle wall breaches are critical due to proximity to neural elements, increasing complication risk.
O-arm navigation's effectiveness in minimizing critical breaches and complications in complex spinal deformity was analyzed.

Purpose of the Study:

To evaluate the effectiveness of O-arm navigation in reducing critical pedicle wall breaches during complex spinal deformity surgery.
To assess the impact of O-arm navigation on surgical complications and efficiency.

Main Methods:

Prospective analysis of 21 complex spinal deformity cases managed with O-arm-navigated posterior-instrumented fusions.
Preoperative assessment included scoliosis type, deformity magnitude, and pedicle anatomy (Watanabe classification).
O-arm used for intraoperative and postoperative screw placement confirmation and grading; variables analyzed included surgery duration, blood loss, complications, and radiation exposure.

Main Results:

Out of 384 pedicles instrumented in 21 patients, 22 breaches (5.7%) were observed.
Three breaches (>2 mm) were classified as biomechanically significant (1.2%), requiring revision (two medial, one inferior).
Overall accuracy rate for pedicle screw placement was 98.8%, with 14 nonsignificant breaches (<2 mm).

Conclusions:

O-arm navigation significantly decreased the incidence of critical (medial and inferior >2 mm) pedicle screw breaches in patients with deformed pedicles.
The O-arm system minimized operative time, reduced estimated blood loss, and lowered the overall incidence of complications.
O-arm navigation offers improved safety and efficiency for pedicle screw placement in complex spinal deformity surgery.