Fluoroscopy-Assisted Freehand Versus 3D-Navigated Imaging-Assisted Pedicle Screw Insertion: A Multicenter Study

Area of Science:

• Spine Surgery
• Orthopedic Surgery
• Neurosurgery
• Medical Imaging

Background:

• Pedicle screw placement is a standard surgical technique for spinal fixation.
• High rates of pedicle screw misplacement persist despite advancements in surgical expertise.
• Intraoperative imaging, including spinal neuronavigation and CT, enhances screw placement accuracy and safety.

Purpose of the Study:

• To compare the accuracy and safety of pedicle screw placement using O-arm imaging with StealthStation navigation versus conventional fluoroscopy (C-arm).
• To evaluate the impact of each imaging modality on screw misplacement rates and surgical outcomes.

Main Methods:

• Retrospective analysis of 1288 pedicle screws placed in 222 patients between 2018 and 2020.
• Patients were divided into two groups: conventional fluoroscopy (C-arm) and O-arm with StealthStation navigation.
• Screw accuracy was assessed postoperatively using CT imaging and classified using the Gertzbein-Robbins criteria.

Main Results:

• The O-arm group demonstrated a higher accuracy rate (98.13%) compared to the C-arm group (92.78%).
• The O-arm group showed a reduction in medial and anterior breaches.
• Reoperation rates for screw misplacement were lower in the O-arm group (2 patients) compared to the C-arm group (5 patients).

Conclusions:

• O-arm intraoperative imaging with spinal navigation significantly enhances pedicle screw placement accuracy over conventional fluoroscopy.
• This improved accuracy leads to a reduction in screw misplacement and associated postoperative complications.
• The O-arm system with navigation is a valuable tool for improving safety and outcomes in spinal fixation surgery.