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Related Experiment Video

Updated: Jan 11, 2026

A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement
06:24

A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement

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Accuracy of Thoracolumbar Pedicle Screws Using Routine O-Arm Intraoperative Navigation-A 15-Year Review With Over

Alexander Shao-Rong Pang1, Fang Nian Joanne Lim1, Pirateb Paramasivam Meenakshi Sundaram2

  • 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Spine
|November 11, 2025
PubMed
Summary

This 15-year study found that O-arm navigation for thoracolumbar pedicle screw placement achieved 98.63% accuracy, with a low major breach rate of 0.55%. This navigation technique enhances surgical safety and precision in spinal instrumentation.

Keywords:
intraoperative imaginglumbar vertebraesacral vertebraespinal navigationthoracic vertebrae

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Spinal Instrumentation

Background:

  • Pedicle screw instrumentation is vital for thoracolumbar spine stabilization.
  • Precise screw placement is critical to avoid complications such as nerve injury, vascular damage, or pedicle fractures.
  • While freehand and fluoroscopic techniques are common, three-dimensional (3D) intraoperative navigation offers enhanced safety and accuracy.

Purpose of the Study:

  • To evaluate the 15-year experience and outcomes of using 3D intraoperative navigation for pedicle screw insertion.
  • To analyze the safety and accuracy of navigation-assisted spinal instrumentation in a large patient cohort.

Main Methods:

  • A retrospective analysis of patients undergoing thoracolumbar and sacral pedicle screw insertion between 2009 and 2023 using intraoperative imaging and navigation.
  • Computed tomography (CT) images were analyzed for pedicle wall breaches using the Gertzbein classification.

Main Results:

  • Analysis of 5,478 pedicle screws revealed an insertion accuracy rate of 98.63%.
  • The rate of major breaches was 0.55%, and the overall breach rate was 1.64%.
  • No patients required reoperation for screw revision.

Conclusions:

  • O-arm navigation is a safe and accurate method for pedicle screw placement, with a low major breach rate (0.55%).
  • No neurovascular injuries occurred in this cohort.
  • Minor breaches were addressed during the initial surgery, and no revisions were needed for malpositioned screws.