{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:41:41Z","timestamp":1787071301595,"version":"build-2736575974"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>C2 transpedicular screw fixation is a biomechanically robust technique for upper cervical stabilization yet remains technically demanding due to anatomical complexity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>This was a retrospective nonrandomized comparative study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Using validated radiological classification systems, this study aims to compare the accuracy, malposition rates, and complication profiles of C2 screw placement using both freehand and navigation-assisted approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>Between 2010 and 2019, 100 patients who underwent C2 pedicle screw fixation at two different institutions were included in a retrospective study. There were 197 screws in all: 45 using a freehand technique (FH group) and 152 using a navigation-assisted approach (NA group). Using both Gertzbein\u2013Robbins classification (GRC) and screw zone classification (SZC), screw accuracy was evaluated. Between the groups, demographic, clinical, and surgical data were statistically compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean age was significantly higher in the NA group (75.37 \u00b1 16.15) than in the FH group (46.29 \u00b1 22.14) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). SZC analysis showed zone 2 placement in 86.7% (FH) and 87.5% (NA) of screws (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.028). GRC analysis revealed that 13.3% of FH screws and 12.5% of NA screws were malpositioned (Grades B\u2013D). No neurovascular complications or screw-related revisions occurred in either group. However, five patients in the NA group required revision due to wound dehiscence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In C2 pedicle screw placement, both freehand and navigation-assisted techniques showed great accuracy and low complication rates. Although navigation systems provide improved accuracy in the hands of experienced users, the freehand technique remains a safe and efficient alternative. Surgeon experience, patient anatomy, and institutional resources should all help guide the choice of technique.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jcvjs.jcvjs_144_25","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T13:01:54Z","timestamp":1763643714000},"page":"423-427","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of freehand versus navigation-assisted C2 pedicle screw fixation: A retrospective accuracy and safety analysis"],"prefix":"10.4103","volume":"16","author":[{"given":"Ilker","family":"Kiraz","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak","family":"Eral","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Eskisehir Yunus Emre Public Hospital, Eski\u015fehir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Buse","family":"Sarigul","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Umraniye Research and Training Hospital, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Fatih","family":"Ramazanoglu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Umraniye Research and Training Hospital, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ersin","family":"Haciyakupoglu","sequence":"additional","affiliation":[{"name":"Heinrich Braun Hospital, Department of Neurosurgery, Zwickau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Erdal","family":"Coskun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"R1-20260421","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1302\/0301-620X.55B3.490","article-title":"Atlanto-axial fracture-dislocations. 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radiographic factors and surgeon experience are associated with cortical breach of C2 pedicle screws","volume":"23","author":"Alosh","year":"2010","journal-title":"J Spinal Disord Tech"},{"key":"R13-20260421","doi-asserted-by":"crossref","first-page":"E13","DOI":"10.3171\/2024.9.FOCUS24431","article-title":"Accuracy of cervical pedicle screw placement with a robotic guidance system via the open midline approach","volume":"57","author":"Yamamoto","year":"2024","journal-title":"Neurosurg Focus"},{"key":"R14-20260421","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1007\/s00586-022-07110-4","article-title":"Robotic-guided placement of cervical pedicle screws: Feasibility and accuracy","volume":"31","author":"Kisinde","year":"2022","journal-title":"Eur Spine J"},{"key":"R15-20260421","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1016\/j.spinee.2017.11.010","article-title":"Freehand technique for C2 pedicle and pars screw placement: Is it safe?","volume":"18","author":"Punyarat","year":"2018","journal-title":"Spine J"},{"key":"R16-20260421","first-page":"2995","article-title":"Comparison of the clinical accuracy of cervical (C2-C7) pedicle screw insertion assisted by fluoroscopy, computed tomography-based navigation, and intraoperative three-dimensional C-arm navigation","volume":"123","author":"Liu","year":"2010","journal-title":"Chin Med J (Engl)"},{"key":"R17-20260421","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1186\/s13018-020-01798-0","article-title":"Accuracy and safety of C2 pedicle or pars screw placement: A systematic review and meta-analysis","volume":"15","author":"Azimi","year":"2020","journal-title":"J Orthop Surg Res"}],"container-title":["Journal of Craniovertebral Junction and 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