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Safety and accuracy of cannulated pedicle screw placement in scoliosis surgery: a comparison of robotic-navigation, O-arm-based navigation, and freehand techniques

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Abstract

Purpose

To compare the safety and accuracy of cannulated pedicle screw placement using a robotic-navigation technique, O-arm-based navigation technique, or freehand technique.

Methods

This study analyzed 106 consecutive patients who underwent scoliosis surgery. Thirty-two patients underwent robotic-navigation-assisted pedicle screw insertion (Group 1), 34 patients underwent O-arm-based navigation-guided pedicle screw insertion (Group 2), and 40 patients underwent freehand pedicle screw insertion (Group 3). The primary outcome measure was the accuracy of screw placement. Secondary outcome parameters included operation time, blood loss, radiation exposure, and postoperative stay.

Results

A total of 2035 cannulated pedicle screws were implanted in 106 patients. The accuracy rate of the first pedicle screw placement during operation was significantly greater in Group 1 (94.7%) than in Group 2 (89.2%; P < 0.001). The accuracy rate of pedicle screw placement postoperatively decreased in the order of Group 1 (96.7%) > Group 2 (93.0%) > Group 3 (80.4%; P < 0.01). There were no significant differences in blood loss or postoperative stay among the three groups (P > 0.05). The operation times of Group 1 and Group 2 were significantly longer than that of Group 3 (P < 0.05).

Conclusion

The robotic-navigation and O-arm-based navigation techniques effectively increased the accuracy and safety of pedicle screw insertion alternative to the freehand technique in scoliosis surgery. Compared with the O-arm-based navigation technique, the robotic-navigation technique increases the mean operation time, but also increases the accuracy of pedicle screw placement. A three-dimensional scan after insertion of the K-wire may increase the accuracy of pedicle screw placement in the O-arm-based navigation technique.

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Acknowledgments

We thank Emma Longworth-Mills, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

This work was supported in part by the National Nature Science Foundation (81874022 and 82172483 to Xinyu Liu; 82102522 to Lianlei Wang), Shandong Natural Science Foundation (ZR202102210113 to Lianlei Wang) and Shandong Province Taishan Scholar Project (tsqn202211317 to Lianlei Wang).

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Author notes

  1. Chao Li and Zheng Wang contributed equally to this article.

Authors and Affiliations

  1. Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, Shandong, People’s Republic of China

    Chao Li, Zheng Wang, Donglai Li, Yonghao Tian, Suomao Yuan, Lianlei Wang & Xinyu Liu

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  1. Chao Li
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Contributions

CL and ZW carried out the entire procedure including the study design, data extraction, statistical analysis, manuscript writing and editing. XL and LW conceived of the study, coordinated and participated in the entire process of drafting and editing the manuscript. SY and YT contributed to the study design and data analysis. All authors have contributed significantly. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Lianlei Wang or Xinyu Liu.

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Conflict of interest

The authors declare that they have no any competing interests.

Ethics approval

This study was approved by the ethics committee of Qilu Hospital of Shandong University (KYLL-202208–036) and performed according to the tenets of the Declaration of Helsinki.

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Written informed consent was obtained from all enrolled patients.

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Li, C., Wang, Z., Li, D. et al. Safety and accuracy of cannulated pedicle screw placement in scoliosis surgery: a comparison of robotic-navigation, O-arm-based navigation, and freehand techniques. Eur Spine J 32, 3094–3104 (2023). https://doi.org/10.1007/s00586-023-07710-8

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