{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T09:28:09Z","timestamp":1767950889677,"version":"3.49.0"},"reference-count":14,"publisher":"Pensoft Publishers","issue":"6","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FM"],"abstract":"<jats:p>\n                    \ufeff\n                    <jats:bold>Abstract<\/jats:bold>\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Aim<\/jats:bold>\n                    : The aim of the current study was to determine the intraoperative accuracy of pedicle screw placement using a 3D CT-assisted navigation system with an O-arm in the thoracic, lumbar, and sacral regions of the spine, as well as to investigate the effect of localization on pedicle screw positioning accuracy.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Materials and methods<\/jats:bold>\n                    : This single-center retrospective study was carried out on 180 patients who had open navigated pedicle screw implantation in the sacral, lumbar, and thoracic regions of the spine at our facility between January 2017 and December 2024. All patients underwent intraoperative scanning with the O-arm before and after screw placement and after screw trajectory correction in case of malpositioning. Additionally, early postoperative CT imaging was uniformly performed. The accuracy of screw placement was assessed by an experienced radiologist and a neurosurgeon using the Gertzbein-Robbins Grading Scale.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results<\/jats:bold>\n                    : Intraoperative post-implantation O-arm CT scans revealed 44 (3.5%) malpositioned screws out of 1257 implanted pedicle screws, resulting in 96.5% Grade A screw placement accuracy. Clinically, 98.2% (1234) of the pedicle screws were properly positioned (Grade A + B). Screw placement in the thoracic region correlated with significantly higher grades of malpositioning: Grade C (\u03c1=0.315,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt;0.001) and Grade D (\u03c1=0.191,\n                    <jats:italic>p<\/jats:italic>\n                    =0.010), especially in the upper thoracic spine.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion<\/jats:bold>\n                    : Image-guided 3D O-arm spinal navigation assistance during pedicle screw implantation can lower the risk of screw malpositioning, thus reducing the need for subsequent revision surgery, especially in the upper thoracic segment of the spine.\n                  <\/jats:p>","DOI":"10.3897\/folmed.67.e167131","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T09:48:26Z","timestamp":1766051306000},"source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative accuracy of O-arm navigated pedicle screw placement in the thoracic and lumbo-sacral regions of the spine \u2013 does localization matter?"],"prefix":"10.3897","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5799-1739","authenticated-orcid":true,"given":"Ivo","family":"Kehayov","sequence":"first","affiliation":[{"name":"Medical University of Plovdiv, Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atanas","family":"Davarski","sequence":"additional","affiliation":[{"name":"Medical University of Plovdiv, Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Polina","family":"Angelova","sequence":"additional","affiliation":[{"name":"Medical University of Plovdiv, Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rumyana","family":"Stoyanova","sequence":"additional","affiliation":[{"name":"Medical University of Plovdiv, Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Borislav","family":"Kitov","sequence":"additional","affiliation":[{"name":"St George University Hospital, Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2258","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"167131_B1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.1.FOCUS13499"},{"key":"167131_B2","doi-asserted-by":"crossref","unstructured":"2. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976) 1990; 15:11\u20134.","DOI":"10.1097\/00007632-199001000-00004"},{"key":"167131_B3","doi-asserted-by":"crossref","unstructured":"3. Papalia GF, Vadal\u00e0 G, Russo F, et al. Higher accuracy and better clinical outcomes in navigated thoraco-lumbar pedicle screw fixation versus conventional techniques a systematic review and meta-analysis. Spine 2024; 49:1370\u201380.","DOI":"10.1097\/BRS.0000000000005105"},{"key":"167131_B4","doi-asserted-by":"crossref","unstructured":"4. Perna F, Borghi R, Pilla F, et al. Pedicle screw insertion techniques: an update and review of the literature. Musculokelet Surg 2016; 100:165\u20139.","DOI":"10.1007\/s12306-016-0438-8"},{"key":"167131_B5","doi-asserted-by":"crossref","unstructured":"5. Tian NF, Xu HZ. Image-guided pedicle screw insertion accuracy: a meta-analysis. Int Orthop 2009; 33:895\u2013903.","DOI":"10.1007\/s00264-009-0792-3"},{"key":"167131_B6","doi-asserted-by":"crossref","unstructured":"6. Perdomo-Pantoja A, Ishida W, Zygourakis C, et al. Accuracy of current techniques for placement of pedicle screws in the spine: a comprehensive systematic review and meta-analysis of 51,161 screws. World Neurosurg 2019; 126:664\u201378.","DOI":"10.1016\/j.wneu.2019.02.217"},{"key":"167131_B7","doi-asserted-by":"crossref","unstructured":"7. Waschke A, Walter J, Duenisch P, et al. CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4,500 screws. Eur Spine J 2013; 22:654\u201360.","DOI":"10.1007\/s00586-012-2509-3"},{"key":"167131_B8","doi-asserted-by":"crossref","unstructured":"8. Charles YP, Ntilikina Y, Collinet A, et al. Accuracy and technical limits of percutaneous pedicle screw placement in the thoracolumbar spine. Surg Radiol Anat 2021; 43:843\u201353.","DOI":"10.1007\/s00276-020-02673-7"},{"key":"167131_B9","doi-asserted-by":"crossref","unstructured":"9. Scheufler KM, Franke J, Eckardt A, et al. Accuracy of image guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing, part I: cervicothoracic spine. Neurosurgery 2011; 69(4):782\u201395.","DOI":"10.1227\/NEU.0b013e318222ae16"},{"key":"167131_B10","doi-asserted-by":"crossref","unstructured":"10. Scheufler KM, Franke J, Eckardt A, et al. Accuracy of image-guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing. Part II: thoracolumbar spine. Neurosurgery 2011; 69(6):1307\u201316.","DOI":"10.1227\/NEU.0b013e31822ba190"},{"key":"167131_B11","doi-asserted-by":"crossref","unstructured":"11. Papalia GF, Vadal\u00e0 G, Russo F, et al. Higher accuracy and better clinical outcomes in navigated thoraco-lumbar pedicle screw fixation versus conventional techniques - a systematic review and meta-analysis. Spine 2024; 49:1370\u201380.","DOI":"10.1097\/BRS.0000000000005105"},{"key":"167131_B12","doi-asserted-by":"crossref","unstructured":"12. Takahashi J, Hirabayashi H, Hashidate H, et al. Accuracy of multilevel registration in image-guided pedicle screw insertion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2010; 35:347\u201352.","DOI":"10.1097\/BRS.0b013e3181b77f0a"},{"key":"167131_B13","doi-asserted-by":"crossref","unstructured":"13. Oertel MF, Hobart J, Stein M, et al. Clinical and methodological precision of spinal navigation assisted by 3D intraoperative O-arm radiographic imaging. J Neurosurg Spine 2011; 14:532\u2013536.","DOI":"10.3171\/2010.10.SPINE091032"},{"key":"167131_B14","doi-asserted-by":"publisher","DOI":"10.25259\/JMSR_132_2024"}],"container-title":["Folia Medica"],"original-title":[],"link":[{"URL":"https:\/\/foliamedica.bg\/article\/167131\/download\/pdf\/","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/foliamedica.bg\/article\/167131\/download\/xml\/","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/foliamedica.bg\/article_preview.php?id=167131&skip_redirect=1","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T07:52:58Z","timestamp":1767945178000},"score":1,"resource":{"primary":{"URL":"https:\/\/foliamedica.bg\/article\/167131\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":14,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,12,18]]}},"URL":"https:\/\/doi.org\/10.3897\/folmed.67.e167131","relation":{},"ISSN":["1314-2143","0204-8043"],"issn-type":[{"value":"1314-2143","type":"electronic"},{"value":"0204-8043","type":"print"}],"subject":[],"published":{"date-parts":[[2025,12,18]]},"article-number":"e167131"}}