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Optimizing Minimally Invasive Spine Surgery: A Fully 3D CT O-Arm Navigated Workflow in MIS TLIF
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Transforming spinal surgery: five years of navigation, workflow optimization and clinical impact
Johannes Groh1, Simon Schramm1, Lilli Holzmann1
1Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
Frontiers in Surgery
|May 6, 2026
Summary
Navigation-assisted spinal instrumentation improves screw accuracy and reduces radiation exposure in trauma centers. Despite a learning curve, it enhances procedural efficiency and safety for complex spinal surgeries.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Medical Technology
Background:
- Navigation-assisted spinal instrumentation offers improved accuracy, efficiency, and safety.
- Real-world implementation and the transition from fluoroscopy to navigation in trauma centers are not well-documented.
Purpose of the Study:
- To evaluate the impact of introducing navigation-assisted spinal instrumentation in a high-volume trauma center.
- To compare outcomes between fluoroscopy-guided and navigation-assisted spinal procedures.
Main Methods:
- Retrospective analysis of 557 dorsal spinal instrumentation procedures (2015-2025) at a Level I trauma center.
- Comparison of 119 navigated cases versus 438 fluoroscopic cases.
- Analysis included demographics, operative time, screw count, radiation parameters, and revision rates.
Main Results:
- Navigation use increased, expanding to complex anatomies and higher-risk patients.
- Operative time per screw decreased after an initial learning curve (27 to 19 minutes).
- Navigation reduced screw misplacement revisions (1% vs. 5%) and radiation time, with comparable total dose.
Conclusions:
- Navigation-assisted spinal instrumentation significantly altered clinical practice in trauma surgery.
- It enhances screw accuracy and reduces radiation exposure, maintaining efficiency post-learning curve.
- Future advancements like robotics and AR will likely expand navigation's role in spinal trauma surgery.
