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. 2024 May;14(4):1337-1346.
doi: 10.1177/21925682221143076. Epub 2022 Dec 1.

Comparison of the Accuracy of Pedicle Screw Placement Using a Fluoroscopy-Assisted Free-Hand Technique with Robotic-Assisted Navigation Using an O-Arm or 3D C-Arm in Scoliosis Surgery

Chao Li  1 , Hao Li  1 , Junxiao Su  1 , Zheng Wang  1 , Donglai Li  1 , Yonghao Tian  1 , Suomao Yuan  1 , Lianlei Wang  1 , Xinyu Liu  1
Affiliations

Comparison of the Accuracy of Pedicle Screw Placement Using a Fluoroscopy-Assisted Free-Hand Technique with Robotic-Assisted Navigation Using an O-Arm or 3D C-Arm in Scoliosis Surgery

Chao Li et al. Global Spine J. 2024 May.

Abstract

Study design: Retrospective.

Objectives: To report and compare the application of robotic-assisted navigation with an O-arm or three-dimensional (3D) C-arm-assisted pedicle screw insertion in scoliosis surgery, and compare with free-hand technique.

Methods: One hundred and forty-four scoliosis patients were included in this study. Ninety-two patients underwent robotic-assisted pedicle screw insertion (Group A), and 52 patients underwent freehand fluoroscopy-guided pedicle screw insertion (Group B). Group A was further divided into Subgroup AI (n = 48; robotic-assisted navigation with an O-arm) and Subgroup AII (n = 44; robotic-assisted navigation with a 3D C-arm). The evaluated clinical outcomes were operation time, blood loss, radiation exposure, postoperative hospital stay, and postoperative complications. The clinical outcomes, coronal and sagittal scoliosis parameters and the accuracy of the pedicle screw placement were assessed.

Results: There were no significant differences in blood loss and postoperative hospital stay between Groups A and B (P = .406, P = .138, respectively). Radiation exposure for patients in Group A (Subgroups AI or AII) was higher than that in Group B (P < .005), and Subgroup AI had higher patient radiation exposure compared with Subgroup AII (P < .005). The operation time in Subgroup AII was significantly longer than that in Subgroup AI and Group B (P = .016, P = .032, respectively). The proportion of clinically acceptable screws was higher in Group A (Subgroups AI or AII) compared with Group B (P < .005).

Conclusions: Robotic-assisted navigation with an O-arm or 3D C-arm effectively increased the accuracy and safety in scoliosis surgery. Compared with robotic-assisted navigation with a 3D C-arm, robotic-assisted navigation with an O-arm was more efficient intraoperatively.

Keywords: 3D C-arm; O-arm; pedicle screw placement; robotic surgery; scoliosis.

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Conflict of interest statement

Declaration of Conflicting InterestsThe 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.
Computed tomography (CT) measurement of apical vertebral rotation. In the axial image, the angle between the axis of the vertebral body and the vertical line is shown. AVR, apical vertebral rotation.
Figure 2.
Figure 2.
Pedicle screw misplacement grading.
Figure 3.
Figure 3.
A 15-years-old female patient was diagnosed with adolescent idiopathic scoliosis (Lenke type 1), and scoliosis surgery using robotic-assisted navigation with an O-arm was performed. Preoperative anteroposterior and lateral plain radiographs of the entire spine (A, B). Anteroposterior and lateral plain radiographs of the entire spine immediately postoperation (C, D).
Figure 4.
Figure 4.
Pedicle screw misplacement. Grade 2 (Right) and grade 1 (Left) misplacement using robotic-assisted navigation with an O-arm (A). Grade 2 (Left) misplacement using robotic-assisted navigation with a three-dimensional (3D) C-arm (B). Grade 2 (Right) and grade 3 (Left) misplacement using a fluoroscopy-assisted free-hand technique (C).
See this image and copyright information in PMC

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