{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:34:10Z","timestamp":1784162050998,"version":"3.55.0"},"reference-count":9,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nFree-hand and fluoroscopic-guided pedicle screw placement has been associated with higher rates of pedicle breaches (frequency range 15\u201340% especially in deformed pedicles). Neurological complications are more \u201ccritical\u201d (i.e., frequent and significant) with medial and inferior pedicle-wall breaches due to the proximity of the neural elements. Here, we analyzed the effectiveness of O-arm navigation in minimizing \u201ccritical\u201d pedicle wall breaches and their complications in 21 complex spinal deformity cases.<\/jats:p>\n<\/jats:sec>\n\nMethods: <\/jats:title>\nTwenty-one complex spinal deformity cases were prospectively managed with O-arm-navigated posterior-instrumented fusions. Preoperative assessment included; evaluation of the type of scoliosis, the magnitude of the deformity, and the anatomy of the pedicles \u2013 (i.e., classified using Watanabe et al<\/jats:italic>.). The O-arm was used to confirm and grade both the intraoperative and postoperative location of screws. Other variables analyzed included; duration of surgery, estimated blood loss, complications, and radiation exposure.<\/jats:p>\n<\/jats:sec>\n\nResults: <\/jats:title>\nIn 21 patients, 259 (63.45%) of 384 pedicles were instrumented; we observed 22 of 259 pedicle screw breaches. Significant (>2 mm) breaches were observed in two medial and one inferior wall cases that required revision; the overall biomechanically significant screw breach rate was (3\/259) 1.2% with an accuracy rate of 98.8%. Pedicle screw placement resulted in another 14 nonsignificant (<2 mm) breaches; ten were medial and four involved the inferior wall. As anterior, lateral, and \u201cin-out-in\u201d trajectory pedicle screws beaches were nonsignificant, they were not included in our analysis.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nO-arm navigation decreased the incidence of medial and inferior (i.e., >2 mm \u201ccritical\u201d) pedicle screw breaches applied in 21 patients with deformed pedicles due to scoliosis. Further, the O-arm minimized the operating time, decreased the estimated blood loss, and reduced the incidence of complications.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_437_2023","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T06:21:24Z","timestamp":1693549284000},"page":"306","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["\u201cCritical pedicle wall\u201d breaches analysis in complex spinal deformity using O-arm navigation"],"prefix":"10.25259","volume":"14","author":[{"given":"Ajay Ramesh","family":"Kothari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddharth Manik","family":"Katkade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pramod Dashrath","family":"Bhilare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddharth","family":"Aiyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishad Vipul","family":"Situt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shailesh Ramakant","family":"Hadgaonkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok","family":"Shyam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parag Kantilal","family":"Sancheti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2023,9,1]]},"reference":[{"key":"10.25259\/SNI_437_2023\/ref-1","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s00586-011-2011-3","article-title":"Accuracy of pedicle screw placement: A systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques","volume":"21","author":"Gelalis","year":"2012","journal-title":"Eur Spine J"},{"key":"10.25259\/SNI_437_2023\/ref-2","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s005860000146","article-title":"Accuracy of pedicle screw insertion with and without computer assistance: A randomised controlled clinical study in 100 consecutive patients","volume":"9","author":"Laine","year":"2000","journal-title":"Eur Spine J"},{"key":"10.25259\/SNI_437_2023\/ref-3","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1007\/s00586-010-1316-y","article-title":"Complications associated with thoracic pedicle screws in spinal deformity","volume":"19","author":"Li","year":"2010","journal-title":"Eur Spine J"},{"key":"10.25259\/SNI_437_2023\/ref-4","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/00003086-199809000-00006","article-title":"Pedicle screw placement using image guided techniques","volume":"354","author":"Merloz","year":"1998","journal-title":"Clin Orthop Relat Res"},{"key":"10.25259\/SNI_437_2023\/ref-5","doi-asserted-by":"crossref","first-page":"163","DOI":"10.4103\/0019-5413.62083","article-title":"Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine","volume":"44","author":"Rajan","year":"2010","journal-title":"Indian J Orthop"},{"key":"10.25259\/SNI_437_2023\/ref-6","doi-asserted-by":"crossref","first-page":"2339","DOI":"10.1007\/s00586-017-5453-4","article-title":"Accuracy of pedicle screw insertion by AIRO\u00ae intraoperative CT in complex spinal deformity assessed by a new classification based on technical complexity of screw insertion","volume":"27","author":"Rajasekaran","year":"2018","journal-title":"Eur Spine J"},{"key":"10.25259\/SNI_437_2023\/ref-7","doi-asserted-by":"crossref","first-page":"E183","DOI":"10.1097\/01.brs.0000157490.65706.38","article-title":"Clinical accuracy of fluoroscopic computer-assisted pedicle screw fixation: A CT analysis","volume":"30","author":"Rampersaud","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.25259\/SNI_437_2023\/ref-8","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1097\/00007632-199702150-00020","article-title":"Accuracy of computer-assisted pedicle screw placement. An in vivo computed tomography analysis","volume":"22","author":"Schwarzenbach","year":"1997","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.25259\/SNI_437_2023\/ref-9","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1097\/BRS.0b013e3181d3cfde","article-title":"A novel pedicle channel classification describing osseous anatomy: How many thoracic scoliotic pedicles have cancellous channels?","volume":"35","author":"Watanabe","year":"2010","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/critical-pedicle-wall-breaches-analysis-in-complex-spinal-deformity-using-o-arm-navigation\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/critical-pedicle-wall-breaches-analysis-in-complex-spinal-deformity-using-o-arm-navigation\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T06:21:28Z","timestamp":1693549288000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/critical-pedicle-wall-breaches-analysis-in-complex-spinal-deformity-using-o-arm-navigation\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,1]]},"references-count":9,"alternative-id":["10.25259\/SNI_437_2023"],"URL":"https:\/\/doi.org\/10.25259\/sni_437_2023","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2023,9,1]]},"article-number":"306"}}