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12.04.2018 | Original Article | Ausgabe 11/2018

European Spine Journal 11/2018

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

European Spine Journal > Ausgabe 11/2018
Sourabh Chachan, Hamid Rahmatullah Bin Abd Razak, Wee Lim Loo, John Carson Allen, Dinesh Shree Kumar
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00586-018-5585-1) contains supplementary material, which is available to authorized users.
The ​original ​version ​of ​this ​article ​was ​revised: The second author name was incorrectly published in original publication. It has been corrected now.
A correction to this article is available online at https://​doi.​org/​10.​1007/​s00586-018-5616-y.



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.

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Supplementary material 1 (PPTX 130 kb)
Supplementary material 2 (XLSX 14 kb)
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