• Martin Mohammed Marzouk, Yama Afghanyar, Mark Mahmoud Marzouk, Sarah Halima Boussouf, Philipp Hartung, and Marcus Richter.
• Spine Center, St. Josefs-Hospital Wiesbaden, Beethovenstraße 20, 65189, Wiesbaden, Hesse, Germany. martin.marzouk@yahoo.com.
• Eur Spine J. 2022 Mar 1; 31 (3): 685-692.

PurposeThis retrospective matched case-control study was conducted to compare two CT based surgery techniques for navigated screw placement in spinal surgery, whether a reduction of radiation exposure and surgery time could be achieved.MethodsWe matched cases treated with an intraoperative CT (iCT), regarding the type and number of implants, with cases treated with a preoperative CT (pCT) of one main surgeon. Outcome measures were radiation exposure due to intraoperative control x-rays, radiation exposure due to CT images, and the duration of surgery.ResultsThe required radiation exposure could be significantly reduced in the iCT group. For the intraoperative control X-rays by 69% (median (MED) 88.50/standard deviation (SD) 107.84 and MED 286.00/SD 485.04 for iCT and pCT respectively-in Gycm2; p < 0.001) and for the CT examinations by 25% (MED 317.00/SD 158.62 and MED 424.50/SD 225.04 for iCT and pCT respectively-in mGycm; p < 0.001) with no significant change in surgery time. The correlation between the number of segments fused and the necessary surgery time decreased significantly for the iCT group (Pearson product-moment-correlation: r = 0.569 and r = 0.804 for iCT and pCT respectively; p < 0.05).ConclusionThe results show that spinal navigation using an intraoperative CT with automatic registration compared to a preoperative CT and intraoperative manual surface registration, allows a significant reduction of radiation exposure, without prolonged surgery time. A significant benefit regarding cut-to-suture-time can be gained with surgeries of a larger scale.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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