Related Experiment Video
Updated: Apr 30, 2026
Optimizing Minimally Invasive Spine Surgery: A Fully 3D CT O-Arm Navigated Workflow in MIS TLIF
Published on: October 17, 2025
[Self-driving, fully motorized C-arm in spinal surgery: a comparative study]
Benno Bullert1, Luca Rübel1, Jochen Franke2
1Klinik für Unfallchirurgie und Orthopädie, Klinik an der Universität Heidelberg, Forschungsgruppe MINTOS (Medical Imaging and Navigation in Trauma and Orthopeadic Surgery), BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
Background:
Intraoperative imaging using mobile C‑arms is well established in spine surgery. Traditionally, the C‑arm operation is performed by "non-sterile" OR staff. The full motorization of mobile C‑arms enables direct control from the sterile field and automated movement paths, potentially improving efficiency and imaging quality.
Objectives:
This prospective single-center study compared the use of a motorized mobile C‑arm (mC-arm) with a non-motorized standard C‑arm (sC-arm) in terms of intraoperative time, motion, and radiation parameters during spinal procedures.
Materials And Methods:
A total of 41 minimally invasive spine surgeries with either ventral or dorsal spondylodesis were included. C‑arm movements were recorded using the system's log files (mC-arm) or IMU sensors (sC-arm). Additionally, radiation exposure and time-related parameters were collected.
Results And Discussion:
In dorsal spondylodesis, there was a trend towards a reduction in the number of 2D images (-17.8%; p = 0.284) with improved collimation (+38.6%; p = 0.077) and a reduction in the dose area product (DAP) (-27.0% p = 0.483) when using the mC-arm, but without significance. In ventral spondylodesis, the use of the mC-arm showed a significant reduction in DAP (-53.0%; p = 0.040), a significant increase in the collimation rate (86.1% vs. 34.7%; p < 0.001), and a tendency towards shorter operating times (-22.0%; p = 0.197).
Conclusion:
The motorization of a mobile C‑arm combined with control from the sterile field can optimize intraoperative imaging and reduce radiation exposure. These findings suggest a substantial potential for workflow improvement that should be further evaluated in future studies.
