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Updated: Sep 12, 2025
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A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement
Published on: May 11, 2020
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Cervical Pedicle Screws: Multicenter Comparison of Freehand, Patient-Specific 3D-Printed Templates, Loop-X Navigation
Alberto Morello1, Stefano Colonna1, Francesco Carbone2,3
1Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", "Città Della Salute e Della Scienza" University Hospital, University of Turin, Italy.
Global Spine Journal
|August 5, 2025
Summary
Patient-specific 3D templates offer superior accuracy for cervical pedicle screws (CPS) insertion compared to freehand and navigation-assisted techniques. This study highlights improved safety and reduced complications with 3D templates in cervical spine fusion.
Area of Science:
- Orthopedics and Spine Surgery
- Medical Device Technology
- Surgical Navigation
Background:
- Cervical pedicle screw (CPS) placement is crucial for spinal instrumentation.
- Accuracy and complication rates vary significantly among different insertion techniques.
- Evidence-based guidance is needed for optimal technique selection in cervical fusion.
Purpose of the Study:
- To compare the accuracy, complication rates, and revision surgery incidence of three CPS insertion techniques.
- To evaluate freehand, navigation-assisted (Loop-X/O-arm), and patient-specific 3D-template guided approaches.
- To provide data supporting decision-making in cervical spine instrumentation.
Main Methods:
- Retrospective, observational study of prospectively collected data from 97 adult patients.
- Analysis of 369 CPS insertions for posterior cervical fusion between January 2019 and August 2024.
- Screw accuracy assessed via CT scans (Gertzbein-Robbins classification); complications systematically evaluated.
Main Results:
- Overall accuracy (Grade A/B) was 90.7%. Patient-specific 3D-templates achieved 97.7% accuracy, significantly higher than navigation-assisted (85.5%) and freehand (80.0%) techniques (P < .001).
- Lowest accuracy observed at C2 level (79.4%). Patients over 60 undergoing C2 surgery had increased risk of suboptimal placement (P = .016).
- Freehand and navigation-assisted groups showed significantly higher complication rates (P < .05).
Conclusions:
- Cervical pedicle screws are safe and effective for cervical fusion with acceptable complication rates.
- Patient-specific 3D templates offer superior accuracy and fewer complications, though applicability may be limited in urgent cases.
- Technique selection should balance surgeon expertise, available resources, and patient-specific factors.
