title: O-arm with navigation versus C-arm: a review of screw placement over 3 years at a major trauma center.
abstract: BACKGROUND
  There is a relatively high incidence of screw misplacement during spinal instrumentation due to distortion of normal anatomy following spinal trauma. The O-arm is the next-generation spinal navigation tool that provides intraoperative 3-D imaging and navigation for spine surgeries.
  
  
  OBJECTIVE
  To evaluate and compare the use of O-arm as compared to C-arm for spinal trauma in a Level I trauma center in India.
  
  
  METHODS
  In this retrospective study over 3 years (July 2010-April 2013), All patients of spinal injury who underwent spinal instrumentation were divided into O-arm group and C-arm group. Accuracy of screw placement was assessed during each surgery in both groups.
  
  
  RESULTS
  A total of 587 patients were evaluated during the study period. There were 278 patients in O-arm group and 309 patients in C-arm group. Both groups were well matched in mean age (27.7 vs. 28.9 years), ASIA grades, and level of injury. The number of screws placed was significantly higher in the C-arm group as compared to the O-arm group (2173 vs. 1720). However, the O-arm group had significantly less screw malplacement rate of 0.93% (n = 16) as compared to malplacement rate in C-arm group of 8.79% (n = 191, p < 0.05).
  
  
  CONCLUSIONS
  Use of O-arm imaging system ensures accurate screw placement and dramatically decreases screw malplacement rate, thus providing better patient safety. Its use is especially beneficial in academic and teaching centers where novice surgeons can attain results equivalent to that of experts in spinal instrumentation.
authors.affiliation: a Department of Neurosurgery , Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences , New Delhi, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Verma
authors.affiliation: a Department of Neurosurgery , Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences , New Delhi, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Singh
authors.affiliation: a Department of Neurosurgery , Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences , New Delhi, India.
authors.forename: D
authors.initials: D
authors.lastname: Agrawal
authors.affiliation: a Department of Neurosurgery , Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences , New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Sinha
authors.affiliation: a Department of Neurosurgery , Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences , New Delhi, India.
authors.forename: D
authors.initials: D
authors.lastname: Gupta
authors.affiliation: a Department of Neurosurgery , Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences , New Delhi, India.
authors.forename: G D
authors.initials: GD
authors.lastname: Satyarthee
authors.affiliation: a Department of Neurosurgery , Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences , New Delhi, India.
authors.forename: B S
authors.initials: BS
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D007194:India; D007223:Infant; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000295:instrumentation*; D000069471:Neurosurgeons; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult
keywords: O-arm; complication; instrumentation; pedicle screw; spinal injury