title: Real-time navigation in spinal surgery: what has changed in surgical practice?
abstract: BACKGROUND
  The authors have carried out a retrospective study to assess the advantages of real-time spinal navigation with 3D-fluoro images (O-arm® and StealthStation® navigation systems, Medtronic, Minneapolis, MN, USA) versus fluoroscopy in spinal surgery. The aim of the study is to ascertain whether this technology has affected surgical indications and clinical practice.
  
  
  METHODS
  From January 2009 to December 2013, 421 patients underwent image-guided spinal surgery procedures in our department. They were divided into two main groups: group 1: operated on with C-arm fluoroscopic control; group 2: operated on with real-time navigation with 3D-fluoro images. All patients with vertebral osteosynthesis underwent a postoperative CT scan to check the final position of the screws.
  
  
  RESULTS
  The screw misplacement proved to be 5.8% in group 1 and 1.5% in group 2. The odds ratio was 4.2 (95% confidence interval 2.3-7.5) with statistical significance (P<0.0001). The results clearly show an increased number of percutaneous procedures in group 2, as well as longer open osteosynthesis.
  
  
  CONCLUSIONS
  Navigation with 3D-fluoro images reduces screw misplacement, facilitates osteosynthesis in the most difficult vertebral segments and allows broader use of percutaneous techniques, when indicated.
authors.affiliation: Department of Neurosurgery, Legnano Civil Hospital, Legnano, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Roccucci
authors.affiliation: Department of Neurosurgery, Legnano Civil Hospital, Legnano, Milan, Italy - ste.peron@libero.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Peron
authors.affiliation: Department of Neurosurgery, Legnano Civil Hospital, Legnano, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Minotti
authors.affiliation: Department of Neurosurgery, Legnano Civil Hospital, Legnano, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Stefini
mesh_terms: D001863:Bone Screws / Q000009:adverse effects; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods