Minimally invasive pedicle screw fixation utilizing O-arm fluoroscopy with computer-assisted navigation: Feasibility, technique, and preliminary results

BACKGROUND: Pedicle screw misplacement is relatively common, with reported rates ranging up to 42%. Although computer-assisted image guidance (CaIG) has been shown to improve accuracy in open spinal surgery, its use in minimally invasive procedures has not been as well evaluated. We present our technique and review the results from a cohort of patients who underwent minimally invasive lumbar pedicle screw placement utilizing the O-arm imaging unit in conjunction with the StealthStation Treon System. METHODS: A retrospective review of patients who underwent minimally invasive pedicle screw fixation with CaIG was performed. Eleven consecutive patients were identified and all were included. Nine patients underwent a single-level transforaminal lumbar interbody fusion. Two patients underwent multi-level fusion. Inaccurate pedicle screw placement was determined by postoperative computed tomography (CT) and graded as 0–2, 2–4, 4–6, or 6–8 mm. RESULTS: A total of 52 screws were placed. Forty screws were inserted in eight patients who had postoperative CT, and a misplacement rate of 7.5% was noted including one lateral and two medial breaches. All breaches were graded as 0–2 mm and were asymptomatic. In the remaining three patients, post-instrumentation O-arm imaging did not demonstrate pedicle screw misplacement. CONCLUSION: Although this initial study evaluates a relatively small number of patients, minimally invasive pedicle screw fixation utilizing the O-arm and StealthStation for CaIG appears to be safe and accurate.