Skip to main content
  • Accuracy Comparison for Intraoperative Biplanar and Volumetric Image Guidance: A Systematic Review

    Final Number:

    Jason Babuska BS; Alan T. Villavicencio MD; Lee Nelson MD; Alexander Mason MD; Sharad Rajpal MD; Sigita Burneikiene MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Recent literature suggests lower rates of pedicle screw misplacement using three-dimensional (3D) navigation when compared to two-dimensional (2D) fluoroscopic image guidance techniques. The present study was undertaken to examine the accuracy of pedicle screw placement by comparing 2D and 3D volumetric intraoperative image guidance techniques.

    Methods: A PubMed literature search was conducted that focused on the accuracy of pedicle screw placement using intraoperative real- time fluoroscopic image guidance. We included papers that were published in English and reported accuracy based results from surgeries, during which virtual, Iso-C, O-arm fluoroscopy or preoperative CT scans fused with intraoperative fluoroscopy navigation techniques for pedicle screw placement were used. The accuracy was assessed for 2D and 3D intraoperative navigation-assisted surgeries comparing it between different spine levels.

    Results: The search yielded 30 studies published from 2003 to 2010 that analyzed the accuracy of pedicle screw placement in 963 patients. There were a total of 4,903 pedicle screws with 4,474 screws placed accurately (91.2% accuracy rate). When comparing accuracy of the two systems, there was a significantly higher rate of misplaced screws when 2D navigation was employed (p < 0.0001). Utilizing 2D fluoroscopic navigation, 12% of the total screws were misplaced versus a misplacement rate of 7.1% using 3D navigation. The same statistically significant tendency (p < 0.0001) and improved accuracy was observed when pedicle screw misplacement rates were compared between the spinal levels: 19.8% vs. 8.9% for thoracic and 9.9% vs. 5.3% for lumbar pedicle screws using 2D and 3D navigation systems, respectively.

    Conclusions: The results of this analysis suggest a significantly greater rate of pedicle screw placement accuracy in lumbar or thoracic spine when 3D intraoperative navigation is used as compared with 2D navigation.

    Patient Care: Improved accuracy in pedicle screw placement during spine surgeries will potentially reduce postoperative complication rates and improve stability of the biomechanical construct.

    Learning Objectives: 1. Demonstrate improved pedicle screw placement accuracy using 3D navigation 2. Discuss pedicle screw placement accuracy at different levels of the spine.


We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy