• Mohammed Banat, Johannes Wach, Abduallah Salemdawod, Majd Bahna, Jasmin Scorzin, and Hartmut Vatter.
• Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn, Bonn, Germany. Electronic address: Mohammed.Banat@ukbonn.de.
• World Neurosurg. 2021 Feb 1; 146: e817-e821.

ObjectiveSpinal dorsal instrumentation is an established treatment option for a range of spinal disorders. In combination with navigation, intraoperative fluoroscopy reduces the risk of incorrectly placing screws. This study aimed to evaluate the efficacy and validity of fluoroscopy (intraoperative navigation with three-dimensional rotation of C-arm vs. O-arm).MethodsIn this retrospective single-center study, 240 patients were included between July 2017 and April 2020. Intraoperative images were acquired using a Siemens-Arcadis Orbic 3D C-arm with a navigation system (Brainlab, AG, Munich, Germany) or using O-arm (Medtronic, Minneapolis, Minnesota, USA) with a navigation system (S7 StealthStation). Finally, we compared mismatches between intraoperative and postoperative computed tomography imaging results using Rampersaud-grade (A-D).ResultsA total of 1614 screws were included: 94 patients in the C-arm group (cAG) and 146 in the O-arm group (oAG). In cAG, 3% (n = 20) of the screws had to be replaced directly due to inadequate positioning with median or lateral breaches, and 3.5 % of screws in oAG (n = 35). An A-score was achieved for 85.7% in the cAG and 87.4% in the oAG. A B-score was found in 11.5% in the cAG and 11.9% in the oAG. In the cAG, a C-score was achieved for 2.5% and in oAG for 0.7%. For 0.3% of the screws, a D-score was found in cAG and for none in oAG.ConclusionsOur study shows that placement of screws using intraoperative imaging in combination with a navigation tool is accurate. Furthermore, navigation coupled with the O-arm had significant advantages in accuracy over navigation with 3D C-arm fluoroscopy. However, both systems offer a high level of accuracy.Copyright © 2020 Elsevier Inc. All rights reserved.

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