title: Clinical and methodological precision of spinal navigation assisted by 3D intraoperative O-arm radiographic imaging.
abstract: OBJECTIVE
  In recent years, the importance of intraoperative navigation in neurosurgery has been increasing. Multiple studies have proven the advantages and safety of computer-assisted spinal neurosurgery. The use of intraoperative 3D radiographic imaging to acquire image information for navigational purposes has several advantages and should increase the accuracy and safety of screw guidance with navigation. The aim of this study was to evaluate the clinical and methodological precision of navigated spine surgery in combination with the O-arm multidimensional imaging system.
  
  
  METHODS
  Thoracic, lumbar, and sacral pedicle screws that were placed with the help of the combination of the O-arm and StealthStation TREON plus navigation systems were analyzed. To evaluate clinical precision, 278 polyaxial pedicle screws in 139 vertebrae were reviewed for medial or caudal perforations on coronal projection. For the evaluation of the methodological accuracy, virtual and intraoperative images were compared, and the angulation of the pedicle screw to the midsagittal line was measured.
  
  
  RESULTS
  Pedicle perforations were recorded in 3.2% of pedicle screws. None of the perforated pedicle screws damaged a nerve root. The difference in angulation between the actual and virtual pedicle screws was 2.8° ± 1.9°.
  
  
  CONCLUSIONS
  The use of the StealthStation TREON plus navigation system in combination with the O-arm system showed the highest accuracy for spinal navigation compared with other studies that used traditional image acquisition and registration for navigation.
authors.affiliation: Department of Neurosurgery, University Hospital Giessen and Marburg GmbH, Giessen, Germany. matthias.oertel@neuro.med.uni-giessen.de
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Oertel
authors.forename: Juliane
authors.initials: J
authors.lastname: Hobart
authors.forename: Marco
authors.initials: M
authors.lastname: Stein
authors.forename: Vanessa
authors.initials: V
authors.lastname: Schreiber
authors.forename: Wolfram
authors.initials: W
authors.lastname: Scharbrodt
mesh_terms: D000368:Aged; D001863:Bone Screws; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D013131:Spine / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*