The accuracy of cervical pedicle screw placement with O-arm-based navigation: A comparison of medial and lateral approaches

Abstract

Introduction: This study aimed to investigate the accuracy of cervical pedicle screw (CPS) placement with O-arm-based navigation (O-arm NAVI) and the differences between medial and lateral approaches.

Methods: We retrospectively reviewed the records of 67 patients (262 CPSs) who underwent posterior instrumentation of the lower cervical spine with CPS between April 2015 and March 2021 in a single institution. The CPSs were categorized into medial (49 patients, 187 CPSs) and lateral (18 patients, 75 CPSs) approach groups. The intraoperative reinsertion and postoperative perforation rates of the two groups were evaluated and compared.

Results: In 12 patients (17.9%) with 16 CPSs, the intraoperative reinsertions of the CPSs were performed. Of the 16 CPSs, 15 were in the medial approach group. The CPS perforations were detected in 17 patients (25.4%) with 21 CPSs (8.0%). No CPS perforations were observed in the lateral approach group where the average angulation of CPS was significantly higher. Both reinsertion and perforation rates were significantly higher at the C4 CPS.

Conclusion: CPSs insertions can be performed more safely using the lateral approach than the medial approach.