European Spine Journal

, Volume 27, Issue 8, pp 1918–1924 | Cite as

Spinal navigation for minimally invasive thoracic and lumbosacral spine fixation: implications for radiation exposure, operative time, and accuracy of pedicle screw placement

  • T. Tajsic
  • K. Patel
  • R. Farmer
  • R. J. Mannion
  • R. A. Trivedi
Original Article



Navigation is emerging as a useful adjunct in percutaneous, minimally invasive spinal surgery (MIS). The aim of this study was to compare C-Arm navigated, O-Arm navigated and conventional 2D-fluoroscopy assisted MIS thoracic and lumbosacral spine fixation techniques in terms of operating time, radiation exposure and accuracy of pedicle screw (PS) placement.


Retrospective observational study of 152 consecutive adults who underwent MIS fixations for spinal instability: 96 2D-fluoroscopy assisted, 39 3D-C-Arm navigated and 27 using O-Arm navigated.


O-Arm navigation significantly reduced PS misplacement (1.23%, p) compared to 3D-C-Arm navigation (7.29%, p = 0.0082) and 2D-fluoro guided placement (5.16%, p = 0379). 3D-C-Arm navigation was associated with lower procedural radiation exposure of the patient (0.4 mSv) than O-Arm navigation (3.24 mSv) or 2D-fluoro guidance (1.5 mSv). Operative time was comparable between three modalities.


O-Arm navigation provides greater accuracy of percutaneous instrumentation placement with an acceptable procedural radiation dose delivered to the patients and comparable operative times.

Graphical abstract

These slides can be retrieved under Electronic Supplementary material.


Minimally invasive (MIS) spinal fixation 2D fluoroscopy 3D fluoroscopy Spinal navigation C-Arm O-Arm 


Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Supplementary material

586_2018_5587_MOESM1_ESM.pptx (168 kb)
Supplementary material 1 (PPTX 168 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • T. Tajsic
    • 1
  • K. Patel
    • 1
  • R. Farmer
    • 2
  • R. J. Mannion
    • 1
  • R. A. Trivedi
    • 1
  1. 1.Division of NeurosurgeryCambridge University Hospital’s NHS Foundation TrustCambridgeUK
  2. 2.Department of RadiologyCambridge University Hospital’s NHS Foundation TrustCambridgeUK

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