Accuracy of pedicle screw fixation under O-arm and navigation guidance in thoracolumbar spine surgery

Abstract

Background: Accurate pedicle screw placement is critical for successful thoracolumbar spine fixation. Misplacement can lead to complications such as neurological injury, vascular damage, and the need for revision surgeries. The use of 3D intraoperative imaging and navigation systems, such as the O-arm and Stealth system, has been proposed to improve screw placement accuracy. This study evaluates the efficacy and safety of these systems for pedicle screw insertion in the thoracolumbar spine. Methods: A prospective, non-randomized study was conducted with 118 patients who underwent thoracolumbar spine fixation between July 2022 and April 2024. A total of 512 pedicle screws were inserted using the O-arm navigation system. Preoperative assessments included X-ray, MRI, and neurological evaluation using the ASIA scale and VAS. The O-arm system was used for real-time 3D imaging, guiding screw placement. Postoperative accuracy was evaluated with an O-arm confirmation scan and classified using the Gertzbein and Robbins scale. Results: The study group included 46 male and 72 female patients, with the mean age of 49.22 years. Degenerative diseases were the most common aetiology. Pedicle screw fixation was performed alone in 32 cases and in combination with decompression or TLIF in 86 cases. Of the 512 screws inserted, 486 (95%) were classified as Grade A (accurate placement). The overall breach rate was 5.07%, with 2.34% requiring intraoperative revision. Notably, no postoperative revisions or neurovascular injuries occurred, and there was no deterioration in ASIA grading or VAS scores. Conclusions: The use of 3D intraoperative imaging and navigation significantly enhances the accuracy and safety of pedicle screw placement in thoracolumbar spine surgery. Routine use of this technology minimizes complications, reduces the need for revision surgeries, and ensures optimal patient outcomes.