An innovative 2D optical navigation workflow for percutaneous pedicle screw fixation in thoracolumbar fractures:...

Thoracolumbar fractures (TLFs) are common spinal injuries caused by high-energy trauma, falls, or osteoporosis. Traditional open surgery may involve substantial blood loss, tissue damage, and prolonged recovery. Percutaneous pedicle screw fixation (PPSF) is minimally invasive and can accelerate rehabilitation, but it often depends on repeated fluoroscopy, increasing radiation exposure and potential neurovascular risk. This study compared the clinical outcomes of two-dimensional (2D) optical navigation and three-dimensional (3D) navigation systems for PPSF in TLFs, focusing on operative time, radiation dose, screw placement accuracy, clinical recovery, complications, and learning curves.

We retrospectively analyzed 105 patients with TLFs who underwent PPSF at our center from January 2020 to February 2024. Patients were divided into a 2D-navigation group (PPSF assisted by a 2D optical navigation system) and a 3D-navigation group (PPSF guided by a 3D navigation system). Intraoperative and postoperative outcomes-including operative time, radiation dose, pedicle screw accuracy, and clinical recovery assessed by visual analog scale (VAS) and Oswestry Disability Index (ODI)-were compared between groups. The learning curve for each system was evaluated using cumulative sum (CUSUM) analysis.

The 2D-navigation group had significantly shorter operative times (94.71 ± 14.38 vs. 105.40 ± 11.22 min) and lower radiation doses (81.0 ± 16.9 vs. 137.2 ± 43.0 µGy·m²) than the 3D-navigation group (P < 0.05). Screw placement accuracy did not differ significantly between groups (2D: 99.2% vs. 3D: 98.1%, P > 0.05). Both groups showed significant postoperative improvements in VAS and ODI scores, with no between-group differences at 1 week, 3 months, or final follow-up (all P > 0.05). No serious complications were observed in either group. CUSUM analysis indicated that proficiency was achieved earlier with 2D navigation (15 cases) than with 3D navigation (29 cases), suggesting a smoother learning curve for the 2D system.

Compared with 3D navigation, 2D optical navigation reduced operative time and radiation exposure while maintaining comparable screw placement accuracy and clinical outcomes. With simpler operation and a shorter learning curve, 2D navigation-assisted PPSF may improve procedural efficiency and represents a promising alternative for minimally invasive treatment of thoracolumbar fractures.