• S Rajasekaran, Manindra Bhushan, Siddharth Aiyer, Rishi Kanna, and Ajoy Prasad Shetty.
• Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India. rajasekaran.orth@gmail.com.
• Eur Spine J. 2018 Sep 1; 27 (9): 2339-2347.

PurposeTo develop a classification based on the technical complexity encountered during pedicle screw insertion and to evaluate the performance of AIRO® CT navigation system based on this classification, in the clinical scenario of complex spinal deformity.Materials And Methods31 complex spinal deformity correction surgeries were prospectively analyzed for performance of AIRO® mobile CT-based navigation system. Pedicles were classified according to complexity of insertion into five types. Analysis was performed to estimate the accuracy of screw placement and time for screw insertion. Breach greater than 2 mm was considered for analysis.Results452 pedicle screws were inserted (T1-T6: 116; T7-T12: 171; L1-S1: 165). The average Cobb angle was 68.3° (range 60°-104°). We had 242 grade 2 pedicles, 133 grade 3, and 77 grade 4, and 44 pedicles were unfit for pedicle screw insertion. We noted 27 pedicle screw breach (medial: 10; lateral: 16; anterior: 1). Among lateral breach (n = 16), ten screws were planned for in-out-in pedicle screw insertion. Among lateral breach (n = 16), ten screws were planned for in-out-in pedicle screw insertion. Average screw insertion time was 1.76 ± 0.89 min. After accounting for planned breach, the effective breach rate was 3.8% resulting in 96.2% accuracy for pedicle screw placement.ConclusionThis classification helps compare the accuracy of screw insertion in range of conditions by considering the complexity of screw insertion. Considering the clinical scenario of complex pedicle anatomy in spinal deformity AIRO® navigation showed an excellent accuracy rate of 96.2%.

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