{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:49:16Z","timestamp":1782452956378,"version":"3.54.5"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"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>Objective<\/jats:title>\n                    <jats:p>Thoracolumbar fractures (TLFs) are common spinal injuries caused by high-energy trauma, falls, or osteoporosis. Traditional open surgery may involve substantial blood loss, tissue damage, and prolonged recovery. Percutaneous pedicle screw fixation (PPSF) is minimally invasive and can accelerate rehabilitation, but it often depends on repeated fluoroscopy, increasing radiation exposure and potential neurovascular risk. This study compared the clinical outcomes of two-dimensional (2D) optical navigation and three-dimensional (3D) navigation systems for PPSF in TLFs, focusing on operative time, radiation dose, screw placement accuracy, clinical recovery, complications, and learning curves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 105 patients with TLFs who underwent PPSF at our center from January 2020 to February 2024. Patients were divided into a 2D-navigation group (PPSF assisted by a 2D optical navigation system) and a 3D-navigation group (PPSF guided by a 3D navigation system). Intraoperative and postoperative outcomes\u2014including operative time, radiation dose, pedicle screw accuracy, and clinical recovery assessed by visual analog scale (VAS) and Oswestry Disability Index (ODI)\u2014were compared between groups. The learning curve for each system was evaluated using cumulative sum (CUSUM) analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 2D-navigation group had significantly shorter operative times (94.71\u2009\u00b1\u200914.38 vs. 105.40\u2009\u00b1\u200911.22\u2005min) and lower radiation doses (81.0\u2009\u00b1\u200916.9 vs. 137.2\u2009\u00b1\u200943.0\u2005\u00b5Gy\u00b7m\n                      <jats:sup>2<\/jats:sup>\n                      ) than the 3D-navigation group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). Screw placement accuracy did not differ significantly between groups (2D: 99.2% vs. 3D: 98.1%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). Both groups showed significant postoperative improvements in VAS and ODI scores, with no between-group differences at 1 week, 3 months, or final follow-up (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). No serious complications were observed in either group. CUSUM analysis indicated that proficiency was achieved earlier with 2D navigation (15 cases) than with 3D navigation (29 cases), suggesting a smoother learning curve for the 2D system.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Compared with 3D navigation, 2D optical navigation reduced operative time and radiation exposure while maintaining comparable screw placement accuracy and clinical outcomes. With simpler operation and a shorter learning curve, 2D navigation-assisted PPSF may improve procedural efficiency and represents a promising alternative for minimally invasive treatment of thoracolumbar fractures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1801856","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:44:07Z","timestamp":1782452647000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["An innovative 2D optical navigation workflow for percutaneous pedicle screw fixation in thoracolumbar fractures: comparison with O-arm 3D navigation"],"prefix":"10.3389","volume":"13","author":[{"given":"Ren","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Orthopedics, General Hospital of Central Theater Command of the PLA of China","place":["Wuhan, Hubei, China"]},{"name":"The First School of Clinical Medicine, Southern Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kangheng","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Central Theater Command of the PLA of China","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Central Theater Command of the PLA of China","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Central Theater Command of the PLA of China","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuepeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Central Theater Command of the PLA of China","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanjun","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Central Theater Command of the PLA of China","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biwang","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Central Theater Command of the PLA of China","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Central Theater Command of the PLA of China","place":["Wuhan, Hubei, China"]},{"name":"The First School of Clinical Medicine, Southern Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengjie","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Central Theater Command of the PLA of China","place":["Wuhan, Hubei, China"]},{"name":"The First School of Clinical Medicine, Southern Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1007\/s10143-024-02553-3","article-title":"Thoracolumbar fracture and spinal cord injury in blunt trauma: a systematic review, meta-analysis, and meta-regression","volume":"47","author":"Azizi","year":"2024","journal-title":"Neurosurg Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"11696","DOI":"10.1038\/s41598-025-94871-9","article-title":"Trends in prevalence of spine fractures and risk factors in spine fractures among US adults, 1999\u20132018","volume":"15","author":"Niu","year":"2025","journal-title":"Sci Rep"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1977","DOI":"10.1007\/s00068-024-02625-5","article-title":"Fractures of the thoracolumbar spine in osteoporosis","volume":"50","author":"Komadina","year":"2024","journal-title":"Eur J Trauma Emerg Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"19170","DOI":"10.1038\/s41598-024-69780-y","article-title":"Epidemiological characteristics of traumatic spinal fractures among the elderly in China","volume":"14","author":"Gu","year":"2024","journal-title":"Sci Rep"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1007\/s00068-023-02247-3","article-title":"ESTES Recommendation on thoracolumbar spine fractures: January 2023","volume":"50","author":"Wendt","year":"2024","journal-title":"Eur J Trauma Emerg Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"501","DOI":"10.21037\/jss-24-14","article-title":"The use of thoracolumbar spinal orthosis in thoracolumbar fractures","volume":"10","author":"Alharbi","year":"2024","journal-title":"J Spine Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e61369","DOI":"10.7759\/cureus.61369","article-title":"Open versus percutaneous stabilization of thoracolumbar fractures: a large retrospective analysis of safety and reoperation rates","volume":"16","author":"Peters","year":"2024","journal-title":"Cureus"},{"key":"B8","doi-asserted-by":"publisher","first-page":"5558","DOI":"10.3390\/jcm13185558","article-title":"Outcome measures of open versus minimally invasive surgery for thoracolumbar spinal traumatic fractures: a systematic review and meta-analysis","volume":"13","author":"Esposito","year":"2024","journal-title":"J Clin Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2040","DOI":"10.3390\/medicina60122040","article-title":"Evaluation of pedicle screw position on computerized tomography using three-dimensional reconstruction software","volume":"60","author":"Park","year":"2024","journal-title":"Medicina (Kaunas)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"903","DOI":"10.31616\/asj.2024.0325","article-title":"Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review","volume":"18","author":"Mulyadi","year":"2024","journal-title":"Asian Spine J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"5460","DOI":"10.3390\/jcm13185460","article-title":"Challenges in contemporary spine surgery: a comprehensive review of surgical, technological, and patient-specific issues","volume":"13","author":"Mensah","year":"2024","journal-title":"J Clin Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"432","DOI":"10.14245\/ns.2448090.045","article-title":"The utility and feasibility of smart glasses in spine surgery: minimizing radiation exposure during percutaneous pedicle screw insertion","volume":"21","author":"Hiranaka","year":"2024","journal-title":"Neurospine"},{"key":"B13","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1186\/s12891-023-06880-2","article-title":"Radiation exposure for pedicle screw placement with three different navigation system and imaging combinations in a Sawbone model","volume":"24","author":"Beisemann","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"key":"B14","doi-asserted-by":"publisher","first-page":"102769","DOI":"10.1016\/j.bas.2024.102769","article-title":"Comparison of 3D-navigation and fluoroscopic guidance in percutaneous pedicle screw placement for traumatic fractures of the thoracolumbar junction","volume":"4","author":"Brunken","year":"2024","journal-title":"Brain Spine"},{"key":"B15","doi-asserted-by":"publisher","first-page":"104165","DOI":"10.1016\/j.bas.2024.104165","article-title":"Current state and future perspectives of spinal navigation and robotics-an AO spine survey","volume":"5","author":"Motov","year":"2025","journal-title":"Brain Spine"},{"key":"B16","doi-asserted-by":"publisher","first-page":"5853","DOI":"10.3390\/jcm11195853","article-title":"High accuracy and safety of intraoperative CT-guided navigation for transpedicular screw placement in revision spinal surgery","volume":"11","author":"Li","year":"2022","journal-title":"J Clin Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"101831","DOI":"10.1016\/j.jmir.2024.101831","article-title":"A systematic review and meta-analysis of radiation exposure in spinal surgeries: comparing C-arm, CT navigation, and O-arm techniques","volume":"56","author":"Shirbache","year":"2025","journal-title":"J Med Imaging Radiat Sci"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1056\/nejm197705052961806","article-title":"The cusum plot: its utility in the analysis of clinical data","volume":"296","author":"Wohl","year":"1977","journal-title":"N Engl J Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1038\/s41598-020-57693-5","article-title":"Augmented reality navigation with intraoperative 3D imaging vs fluoroscopy-assisted free-hand surgery for spine fixation surgery: a matched-control study comparing accuracy","volume":"10","author":"Elmi-Terander","year":"2020","journal-title":"Sci Rep"},{"key":"B20","doi-asserted-by":"publisher","first-page":"27214","DOI":"10.1038\/s41598-025-12549-8","article-title":"A comparative study of robot-assisted navigation versus C-arm fluoroscopy in percutaneous pedicle screw fixation for the treatment of thoracolumbar fractures","volume":"15","author":"Liang","year":"2025","journal-title":"Sci Rep"},{"key":"B21","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1186\/s13018-025-06111-5","article-title":"Comprehensive workflow with optical navigation in minimally invasive transforaminal lumbar interbody fusion: a retrospective study","volume":"20","author":"Niu","year":"2025","journal-title":"J Orthop Surg Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"17652","DOI":"10.1038\/s41598-019-53472-z","article-title":"Radiation exposure of patient and operating room personnel by fluoroscopy and navigation during spinal surgery","volume":"9","author":"Bratschitsch","year":"2019","journal-title":"Sci Rep"},{"key":"B23","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1186\/s13019-024-03182-z","article-title":"Intraoperative patient radiation dose from cone-beam computed tomography in thoracic surgery","volume":"19","author":"Kohmaru","year":"2024","journal-title":"J Cardiothorac Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1111\/os.14260","article-title":"A more efficient and safer improved percutaneous pedicle screw insertion technique-trajectory dynamic adjustment technique, technical note, and clinical efficacy","volume":"17","author":"Li","year":"2025","journal-title":"Orthop Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"111","DOI":"10.4184\/asj.2016.10.1.111","article-title":"Percutaneous transpedicular fixation: technical tips and pitfalls of sextant and pathfinder systems","volume":"10","author":"Mohi Eldin","year":"2016","journal-title":"Asian Spine J"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1016\/j.otsr.2019.03.003","article-title":"Mismatch between rod bending and actual post-operative lordosis in lumbar arthrodesis with poly axial screws","volume":"105","author":"Moufid","year":"2019","journal-title":"Orthop Traumatol Surg Res"},{"key":"B27","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1007\/s11701-024-01852-7","article-title":"Cognitive ergonomics and robotic surgery","volume":"18","author":"Wong","year":"2024","journal-title":"J Robot Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"124295","DOI":"10.1016\/j.wneu.2025.124295","article-title":"Innovation fatigue in spine surgery: are we doing too much, too fast?","volume":"202","author":"Mathkour","year":"2025","journal-title":"World Neurosurg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1872","DOI":"10.1016\/j.spinee.2024.05.013","article-title":"Level-specific comparison of 3D navigated and robotic arm-guided screw placement: an accuracy assessment of 1210 pedicle screws in lumbar surgery","volume":"24","author":"Asada","year":"2024","journal-title":"Spine J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"27759","DOI":"10.1038\/s41598-024-77191-2","article-title":"Comparison of different imaging devices and navigation systems for cervical pedicle screw placement: an experimental study on screw accuracy, screw placement time and radiation dose","volume":"14","author":"Mandelka","year":"2024","journal-title":"Sci Rep"},{"key":"B31","doi-asserted-by":"publisher","first-page":"105899","DOI":"10.1016\/j.bas.2025.105899","article-title":"Comparative analysis of the pedicle screw accuracy, screw revision and loosening rate and radiation exposure of robotic-guided (RG), intraoperative computed tomography (iCT)-navigation guided, and fluoroscopy guided placement technique","volume":"6","author":"Pojski\u0107","year":"2025","journal-title":"Brain Spine"},{"key":"B32","doi-asserted-by":"publisher","first-page":"4463","DOI":"10.3390\/jcm14134463","article-title":"Robotic-guided spine surgery: implementation of a system in routine clinical practice-an update","volume":"14","author":"Pojski\u0107","year":"","journal-title":"J Clin Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"12344","DOI":"10.1038\/s41598-022-16709-y","article-title":"Comparison of three imaging and navigation systems regarding accuracy of pedicle screw placement in a Sawbone model","volume":"12","author":"Beisemann","year":"2022","journal-title":"Sci Rep"},{"key":"B34","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1007\/s00586-023-08094-5","article-title":"Accuracy of augmented reality-assisted pedicle screw placement: a systematic review","volume":"33","author":"Youssef","year":"2024","journal-title":"Eur Spine J"},{"key":"B35","doi-asserted-by":"publisher","first-page":"2102","DOI":"10.1016\/j.spinee.2024.07.008","article-title":"Comparison of rostral facet joint violations in robotic- and navigation-assisted pedicle screw placement for adult lumbar spine instrumentation","volume":"24","author":"Nilssen","year":"2024","journal-title":"Spine J"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2024.1.Spine23841","article-title":"Impact of bilateral facet joint violation on radiographic degeneration of superior adjacent segments and clinical outcomes","volume":"41","author":"Ding","year":"2024","journal-title":"J Neurosurg Spine"},{"key":"B37","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1007\/s00586-021-06948-4","article-title":"A real-time 3D electromagnetic navigation system for percutaneous pedicle screw fixation in traumatic thoraco-lumbar fractures: implications for efficiency, fluoroscopic time, and accuracy compared with those of conventional fluoroscopic guidance","volume":"31","author":"Yao","year":"2022","journal-title":"Eur Spine J"},{"key":"B38","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1177\/0284185115595667","article-title":"Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice","volume":"57","author":"Alshamari","year":"2016","journal-title":"Acta Radiol"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1801856\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:44:07Z","timestamp":1782452647000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1801856\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":38,"alternative-id":["10.3389\/fsurg.2026.1801856"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1801856","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]},"article-number":"1801856"}}