Does Pedicle Screw Fixation Assisted by O-Arm Navigation Perform Better Than Fluoroscopy-guided Technique in Thoracolumbar Fractures in Percutaneous Surgery?: A Retrospective Cohort Study

A retrospective cohort study. OBJECTIVE: To evaluate the effect of O-arm navigation in percutaneous surgeries for thoracolumbar fracture in comparison to the use of conventional fluoroscopic technique. SUMMARY OF BACKGROUND DATA: O-arm navigation is a progressive surgical tool, with extensive research papers reporting its effects. Whereas, there were not many papers describing its accuracy and facet impingement rate when compared with fluoroscopy-guided technique in percutaneous surgeries, especially at varying fracture levels. MATERIALS AND METHODS: We conducted a retrospective comparative study of 97 consecutive patients of single-level neurological intact thoracolumbar fractures from November 2015 to October 2017 and they were all treated with percutaneous pedicle screw implantation. Screws were classified as 4 grades of perforations and 3 grades of facet joint violation. The association between variables such as anatomic perforation, functional perforation, and facet impingement were investigated by χ(2) test, Fisher exact test or t test. A P-value of <0.05 was considered statistically significant. RESULTS: A total of 573 pedicle screws were implanted and graded. The overall anatomic perforation rate and functional perforation rate were lower in the O-arm group compared with the fluoroscopy group (8.3% vs. 15.0%, P=0.013, 1.1% vs. 4.2%, P=0.024). At fracture level, the rate of grade 2 perforation of the O-arm group was lower than that of the fluoroscopy group (0% vs. 6.1%, P=0.033). Furthermore, the O-arm group obviously reduced the facet impingement rate both at all levels and at fracture levels (P=0.002; 0.02). CONCLUSIONS: In percutaneous pedicle screw placement for neurological intact thoracolumbar fracture, the introduction of O-arm navigation improved accuracy, reduced functional perforations, and minimized serious perforations compared with conventional fluoroscopic technique. It also decreased facet joint violation observably and helped to prevent development of adjacent segment degeneration.