Cervical pedicle screw instrumentation is more reliable with O-arm-based 3D navigation: analysis of cervical pedicle screw placement accuracy with O-arm-based 3D navigation

  • Sourabh Chachan
  • Hamid Rahmatullah Bin Abd Razak
  • Wee Lim Loo
  • John Carson Allen
  • Dinesh Shree Kumar
Original Article



Despite proven biomechanical superiority and resultant superior clinical outcomes, pedicle instrumentation in cervical spine is not widely practiced due to technical difficulties, steep learning curve, and possible potential catastrophic complications due to screw misplacement. This study was undertaken with the purpose to evaluate the feasibility, accuracy, and complications of cervical pedicle screw instrumentation solely using O-arm-based 3D navigation technology.


Prospectively maintained data from a single-surgeon case series were retrospectively analyzed. All the patients had undergone cervical pedicle instrumentation under O-arm 3D navigation. Screw placement accuracy was analyzed and compared among different vertebral levels and also between different patient groups.


A total of 241 cervical pedicle screws were inserted in 44 patients. Out of the 241 screws, 197 (81.74%) were inserted at the level of C3–C6 vertebrae with nearly equal distribution among the 4 vertebrae, followed by 32 (13.28%) and 12 (4.98%) screws at C2 and C7 vertebrae, respectively. After the analysis of screw placement as per Gertzbein classification, the overall breach rates were found to be 7.05% (17 screws) with 52.94% (10 screws) Grade I, 47.06% (7 screws) Grade II, and nil Grade III screw breaches.


The use of O-arm-based intra-operative 3D scans for navigation can make cervical pedicle screw placement reliable. High accuracy and better intra-operative control can increase surgeon’s confidence in using cervical pedicle instrumentation on more regular basis.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Cervical pedicle screw insertion O-arm 3D navigation Accuracy of cervical pedicle screw insertion Complications of cervical pedicle screw insertion 


Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.

Supplementary material

586_2018_5585_MOESM1_ESM.pptx (130 kb)
Supplementary material 1 (PPTX 130 kb)
586_2018_5585_MOESM2_ESM.xlsx (15 kb)
Supplementary material 2 (XLSX 14 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018
corrected publication May 2018

Authors and Affiliations

  • Sourabh Chachan
    • 1
  • Hamid Rahmatullah Bin Abd Razak
    • 1
  • Wee Lim Loo
    • 1
  • John Carson Allen
    • 2
  • Dinesh Shree Kumar
    • 1
  1. 1.Department of OrthopaedicsChangi General HospitalSingaporeSingapore
  2. 2.Centre for Quantitative Medicine, Duke-NUS Medical SchoolSingaporeSingapore

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