• Kaissar Farah, Pierre Coudert, Thomas Graillon, Benjamin Blondel, Henry Dufour, Olivier Gille, and Stephane Fuentes.
• Department of Neurosurgery, La Timone University Hospital, Marseille, France; Spine Unit, La Timone University Hospital, Marseille, France. Electronic address: kaissar.farah@gmail.com.
• World Neurosurg. 2018 Oct 1; 118: e175-e184.

ObjectivePedicle screw placement remains challenging. The present study focuses on the comparison between 2 intraoperative-based neuronavigation systems (O-Arm and AIRO) during thoracolumbar screw instrumentation.MethodsThis is a prospective, comparative, nonrandomized study conducted in 2 French academic centers. The O-Arm was used at the University Hospital of Bordeaux, whereas the AIRO was used at the University Hospital of Marseille. Routine computed tomography was performed on postoperative day 2 to evaluate pedicle screw placement. Measures of radiation exposure were extracted directly from reports provided by each system. The effective dose was calculated.ResultsOverall, 74 screws were placed in 11 patients in the O-Arm group and 84 in 11 patients in the AIRO group. In the first group, 90.8% were rated as acceptable and 92.2% in the second (P > 0.05) according to the Heary and Gertzbein classifications, respectively, for thoracic and lumbar spine. Differences between both implantation systems were significant (P < 0.05) concerning dose length product (235 and 1039 mGy/cm, in O-Arm and AIRO, respectively), overall mean radiation dose received by 1 patient (3.52 and 15.6 mSv in O-Arm and AIRO, respectively), mean radiation dose per single scan (2.58 and 8.7 mSv in O-Arm and AIRO, respectively), mean effective dose per instrumented level (1.04 and 3.9 mSv in O-Arm and AIRO, respectively), and radiation dose received by the primary surgeon (0.63 and 0 μSv in O-Arm and AIRO, respectively).ConclusionsIntraoperative computed tomography-based navigation is a major innovation that improves the accuracy of pedicle screw positioning with acceptable patient radiation exposure and reduced surgical team exposure.Copyright © 2018 Elsevier Inc. All rights reserved.

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