{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T20:20:42Z","timestamp":1785529242417,"version":"3.56.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pedicle screw (PS) fixation provides superior biomechanical stability compared with lateral mass screw (LMS) fixation for unstable cervical spine fractures (CS-Fx) but is associated with a risk of neurovascular injury. Navigation systems have improved PS placement accuracy, although most published studies remain small and underpowered to assess rare complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the accuracy and safety of navigation-assisted PS fixation for unstable CS-Fx in a population-based cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All consecutive patients with unstable CS-Fx who underwent navigated PS fixation at Oslo University Hospital between 2015 and 2024 were included in this study. Navigation was performed using preoperative CT-based surface matching. Postoperative CT scans obtained within 24\u2005h were used to grade PS accuracy as Grade 1 (&amp;lt;2\u2005mm breach), Grade 2 (2\u20134\u2005mm), or Grade 3 (&amp;gt;4\u2005mm). Complications related to PS placement were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 345 patients (median age 68 years; 75% males) underwent fixation with 1,347 navigated PSs. Screw accuracy was Grade 1 in 90% of cases, Grade 2 in 8% of cases, and Grade 3 in 2% of cases. Surgery-related complications occurred in 23 patients (6.7%), of whom 11 experienced complications directly related to PS placement. The per-screw complication risk was 0.8%, increasing with decreasing accuracy: 0.1% (Grade 1), 6% (Grade 2), and 14% (Grade 3). Vertebral artery injury occurred in seven patients; two patients experienced new-onset nerve root injury, one had a misplaced screw breaching the atlanto-occipital joint, and one developed significant perioperative bleeding. No cases of new-onset spinal cord injury or screw pull-out were observed. Surgical site infections occurred in 3.5% of patients and were successfully treated with debridement and antibiotics in all cases, without the need for implant removal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Navigated cervical PS fixation is accurate and associated with a low rate of serious complications. Meticulous planning and surgical technique remain essential despite the use of navigation assistance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1773142","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:42:16Z","timestamp":1771569736000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Accuracy and safety of navigated pedicle screw insertion in cervical spine fractures"],"prefix":"10.3389","volume":"13","author":[{"given":"Jalal","family":"Mirzamohammadi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tor Arn\u00f8y","family":"Austad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidar","family":"Stenset","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donata Iwona","family":"Biernat","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mads","family":"Aarhus","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Oslo University Hospital","place":["Oslo, Norway"]},{"name":"Faculty of Medicine, University of Oslo","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirik","family":"Helseth","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Oslo University Hospital","place":["Oslo, Norway"]},{"name":"Faculty of Medicine, 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