Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr;12(3):447-451.
doi: 10.1177/2192568220956979. Epub 2020 Oct 1.

Transpedicular Screw Placement Accuracy Using the O-Arm Versus Freehand Technique at a Single Institution

Benjamin D Crawford  1 , Corbyn M Nchako  1 , Kelsey A Rebehn  2 , Heidi Israel  2 , Howard M Place  2
Affiliations

Transpedicular Screw Placement Accuracy Using the O-Arm Versus Freehand Technique at a Single Institution

Benjamin D Crawford et al. Global Spine J. 2022 Apr.

Abstract

Study design: Retrospective cohort.

Objective: The objective of this study was to assess the effectiveness of the O-arm as an intraoperative imaging tool by comparing accuracy of pedicle screw placement to freehand technique.

Methods: The study comprised a total of 1161 screws placed within the cervical (n = 187) thoracic (n = 657), or lumbar (n = 317) spinal level. A pedicle breach was determined by any measurable displacement of the screw outside of the pedicle cortex in any plane on postoperative images. Each pedicle screw was subsequently classified by its placement relative to the targeted pedicle. Statistical analysis was then performed to determine the frequency and type of pedicle screw mispositioning that occurred using the O-arm versus freehand technique.

Results: A total of 155 cases (O-arm 84, freehand 71) involved the placement of 454 pedicle screws in the O-arm group and 707 pedicle screws in the freehand group. A pedicle breach occurred in 89 (12.6%) screws in the freehand group and 55 (12.1%) in the O-arm group (P = .811). Spinal level operated upon did not influence pedicle screw accuracy between groups (P > .05). Three screws required revision surgery between the 2 groups (O-arm 1, freehand 2, P > .05). The most frequent breach type was a lateral pedicle breach (O-arm 22/454, 4.8%; freehand 54/707, 7.6%), without a significant difference between groups (P > .05).

Conclusions: The use of the O-arm coupled with navigation does not assure improved transpedicular screw placement accuracy when compared with the freehand technique.

Keywords: CT; cervical; fusion; lumbar; navigation; pedicle screw; spinal; thoracic; trauma.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
No breach of the pedicle.
Figure 2.
Figure 2.
Lateral breach of the pedicle.
See this image and copyright information in PMC

References

    1. Sembrano JN, Polly DW, Jr, Ledonio CG, Santos ER. Intraoperative 3-dimensional imaging (O-arm) for assessment of pedicle screw position: does it prevent unacceptable screw placement? Int J Spine Surg. 2012;6:49–54. doi:10.1016/j.ijsp.2011.11.002 - PMC - PubMed
    1. Perna F, Borghi R, Pilla F, Stefanini N, Mazzotti A, Chehrassan M. Pedicle screw insertion techniques: an update and review of the literature. Musculokelet Surg. 2016;100:165–169. doi:10.1007/s12306-016-0438-8 - PubMed
    1. Kim YJ, Lenke LG, Cheh G, Riew KD. Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: a comparison with computerized tomography. Spine (Phila Pa 1976). 2005;30:2084–2088. doi:10.1097/01.brs.0000178818.92105.ec - PubMed
    1. Farber GL, Place HM, Mazur RA, Jones DE, Damiano TR. Accuracy of pedicle screw placement in lumbar fusions by plain radiographs and computed tomography. Spine (Phila Pa 1976). 1995;20:1494–1499. doi:10.1097/00007632-199507000-00010 - PubMed
    1. Verma SK, Singh PK, Agrawal D, et al. O-arm with navigation versus C-arm: a review of screw placement over 3 years at a major trauma center. Br J Neurosurg. 2016;30:658–661. doi:10.1080/02688697.2016.1206179 - PubMed

LinkOut - more resources