The major limitation of computer-based 3D fluoroscopy is increased radiation exposure of patients and the operating-room (OR) team. Adjunction of spine navigation to intraoperative 3D fluoroscopy (io3DF) can likely overcome this shortcoming while increasing the pedicle screw accuracy rate. The purpose of the study is compare data from a cohort of patients undergoing lumbar percutaneous pedicle screw (PPS) placement utilizing io3DF alone or in combination with spine navigation.

We performed a cohort study of 168 patients who underwent PPS implantation between 2009 and 2016. Our primary endpoint was to compare the pedicle screw accuracy between the two groups. The secondary endpoints were to compare the exposure of patients and operating room (OR) staff to radiation, duration of surgery, and postoperative complications.

A total of 438 screws were placed without navigation guidance (group 1) and 276 with spine navigation (group 2). The mean patient age in both groups was 58.6 years (SD: 14.1). The final pedicle accuracy rate was 97.9% in group 1 and 99.6% in group 2. The average radiation dose per patient was significantly larger in group 1 (571.9mGym²) than in group 2 (365.6mGym²) (P=0.000088). Duration of the surgery and complication rate were not significantly different between the two groups (P>0.05).

The io3D fluoroscopy with spine navigation minimizes radiation doses on the patients and OR team, and increases pedicle screw accuracy with no permanent complications compared to io3DF alone. The setup is recommended, especially in cases with a complex degenerative spine.