Comparison of Accuracy in C1-C2 Pedicle Screw Placement: O-arm, 3D Guides, and C-arm Fluoroscopy

Comparison of Accuracy in C1-C2 Pedicle Screw Placement: O-arm, 3D Guides, and C-arm Fluoroscopy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Comparison of Accuracy in C1-C2 Pedicle Screw Placement: O-arm, 3D Guides, and C-arm Fluoroscopy Yuwei Li, Haijiao Wang, Xiuzhi Li, Wei Cui, Peng Zhou, Xiao Wei, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5944049/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 May, 2025 Read the published version in Scientific Reports → Version 1 posted 12 You are reading this latest preprint version Abstract Objective: To evaluate the accuracy and safety of C1-C2 pedicle screw placement using O-arm navigation, individualized 3D-printed guides, and C-arm fluoroscopy. Methods: Clinical data of 47 patients who underwent C1-C2 spinal fixation surgery at our institution between January 2015 and December 2020 were retrospectively analyzed. The cohort included 28 males and 19 females, aged 15–59 years (mean age: 46.23 ± 9.97 years). Patients were categorized into three groups based on the screw placement technique: navigation group (11 cases; O-arm S8 navigation system), guide group (15 cases; individualized 3D-printed guides), and fluoroscopy group (21 cases; C-arm fluoroscopy guided by anatomical landmarks). Outcome measures included surgical time, screw placement time, intraoperative blood loss, single-pass screw placement success rate, screw placement accuracy, and complication rate. Results: Surgical Metrics: The Navigation group demonstrated a mean surgical time of 120.72 ± 11.14 minutes, screw placement time of 20.00 ± 1.09 minutes, and blood loss of 225.81±25.58 ml. The Guide group reported significantly shorter surgical time (97.46±9.03 minutes, P<0.001), shorter screw placement time (15.80±1.93 minutes, P < 0.001), and reduced blood loss (162.66 ± 18.52 ml, P < 0.001). The Fluoroscopy group showed longer surgical time (121.04±12.81 minutes) and higher blood loss (239.04±24.54 ml) compared to the other groups. Screw Placement Success and Accuracy: A total of 188 screws were placed (44 in the Navigation group, 60; guide group, and 84; Fluoroscopy group). The single-pass success rates were 100% (44/44) in the navigation group, 93.3% (56/60) in the guide group, and 80.9% (68/84) in the fluoroscopy group (P=0.002). Screw placement accuracy was 100% (44/44) in the navigation group, 98.3% (59/60) in the guide group, and 85.7% (72/84) in the fluoroscopy group (P=0.039). Notably, three screws in the fluoroscopy group breached the vertebral artery foramen; however, no cerebrovascular ischemic events were observed. Complications: Two patients in the fluoroscopy group developed postoperative occipitocervical pain owing to intraoperative irritation of the C2 nerve root. Symptoms resolved after corticosteroid and diuretic therapy. No occipitocervical pain or other complications were reported in the Navigation or Guide group. All the incisions healed without infection or delayed recovery. Conclusion: O-arm S8 navigation system and individualized guide plate assisted atlantoaxial screw placement can achieve high and stable accuracy, which is better than the traditional freehand screw placement technique under fluoroscopy; O-arm navigation technology has an advantage in the one-time success rate of atlantoaxial screw placement, which is higher than that of the guide plate group and the fluoroscopy group; Individualized guide plate combined with lateral fluoroscopy can accurately place atlantoaxial screws, save operation time and reduce bleeding. Health sciences/Health care/Therapeutics/Surgery/Reconstruction Health sciences/Medical research/Outcomes research C1-C2 pedicle screw O-arm navigation 3D-printed guide fluoroscopy spinal surgery Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 May, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 16 Apr, 2025 Editor assigned by journal 16 Apr, 2025 Reviews received at journal 11 Apr, 2025 Reviewers agreed at journal 10 Apr, 2025 Reviews received at journal 05 Apr, 2025 Reviewers agreed at journal 05 Apr, 2025 Reviews received at journal 05 Apr, 2025 Reviewers agreed at journal 05 Apr, 2025 Reviewers agreed at journal 03 Apr, 2025 Reviewers invited by journal 03 Apr, 2025 Submission checks completed at journal 02 Apr, 2025 First submitted to journal 01 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5944049","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":438934342,"identity":"29638b05-9100-484f-9dcf-d9a157d4b290","order_by":0,"name":"Yuwei Li","email":"","orcid":"","institution":"Luohe Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuwei","middleName":"","lastName":"Li","suffix":""},{"id":438934343,"identity":"46d09dda-f448-4f9a-8893-8d236aff97e8","order_by":1,"name":"Haijiao Wang","email":"","orcid":"","institution":"Luohe Central 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Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"C1-C2 pedicle screw, O-arm navigation, 3D-printed guide, fluoroscopy, spinal surgery","lastPublishedDoi":"10.21203/rs.3.rs-5944049/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5944049/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo evaluate the accuracy and safety of C1-C2 pedicle screw placement using O-arm navigation, individualized 3D-printed guides, and C-arm fluoroscopy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Clinical data of 47 patients who underwent C1-C2 spinal fixation surgery at our institution between January 2015 and December 2020 were retrospectively analyzed. The cohort included 28 males and 19 females, aged 15–59 years (mean age: 46.23 ± 9.97 years). Patients were categorized into three groups based on the screw placement technique: navigation group (11 cases; O-arm S8 navigation system), guide group (15 cases; individualized 3D-printed guides), and fluoroscopy group (21 cases; C-arm fluoroscopy guided by anatomical landmarks). Outcome measures included surgical time, screw placement time, intraoperative blood loss, single-pass screw placement success rate, screw placement accuracy, and complication rate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eSurgical Metrics: The Navigation group demonstrated a mean surgical time of 120.72 ± 11.14 minutes, screw placement time of 20.00 ± 1.09 minutes, and blood loss of 225.81±25.58 ml. The Guide group reported significantly shorter surgical time (97.46±9.03 minutes, P\u0026lt;0.001), shorter screw placement time (15.80±1.93 minutes, P \u0026lt; 0.001), and reduced blood loss (162.66 ± 18.52 ml, P \u0026lt; 0.001). The Fluoroscopy group showed longer surgical time (121.04±12.81 minutes) and higher blood loss (239.04±24.54 ml) compared to the other groups. Screw Placement Success and Accuracy: A total of 188 screws were placed (44 in the Navigation group, 60; guide group, and 84; Fluoroscopy group). The single-pass success rates were 100% (44/44) in the navigation group, 93.3% (56/60) in the guide group, and 80.9% (68/84) in the fluoroscopy group (P=0.002). Screw placement accuracy was 100% (44/44) in the navigation group, 98.3% (59/60) in the guide group, and 85.7% (72/84) in the fluoroscopy group (P=0.039). Notably, three screws in the fluoroscopy group breached the vertebral artery foramen; however, no cerebrovascular ischemic events were observed. Complications: Two patients in the fluoroscopy group developed postoperative occipitocervical pain owing to intraoperative irritation of the C2 nerve root. Symptoms resolved after corticosteroid and diuretic therapy. No occipitocervical pain or other complications were reported in the Navigation or Guide group. All the incisions healed without infection or delayed recovery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e O-arm S8 navigation system and individualized guide plate assisted atlantoaxial screw placement can achieve high and stable accuracy, which is better than the traditional freehand screw placement technique under fluoroscopy; O-arm navigation technology has an advantage in the one-time success rate of atlantoaxial screw placement, which is higher than that of the guide plate group and the fluoroscopy group; Individualized guide plate combined with lateral fluoroscopy can accurately place atlantoaxial screws, save operation time and reduce bleeding.\u003c/p\u003e","manuscriptTitle":"Comparison of Accuracy in C1-C2 Pedicle Screw Placement: O-arm, 3D Guides, and C-arm Fluoroscopy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-10 19:57:18","doi":"10.21203/rs.3.rs-5944049/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-16T12:16:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-16T11:26:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-11T04:15:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29123950360809954870785198533744274769","date":"2025-04-11T03:33:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-06T02:03:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"35407441491627318761572473185108854888","date":"2025-04-06T01:49:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-05T07:49:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60919527143110642718132587061904754536","date":"2025-04-05T06:25:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263234759032286524700770253253375749774","date":"2025-04-03T18:14:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-03T06:20:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-02T06:36:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-04-01T07:55:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"27ff7982-1055-404d-93c0-60ef430116ce","owner":[],"postedDate":"April 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":46733650,"name":"Health sciences/Health care/Therapeutics/Surgery/Reconstruction"},{"id":46733651,"name":"Health sciences/Medical research/Outcomes research"}],"tags":[],"updatedAt":"2025-05-12T15:59:36+00:00","versionOfRecord":{"articleIdentity":"rs-5944049","link":"https://doi.org/10.1038/s41598-025-99884-y","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-06 15:57:08","publishedOnDateReadable":"May 6th, 2025"},"versionCreatedAt":"2025-04-10 19:57:18","video":"","vorDoi":"10.1038/s41598-025-99884-y","vorDoiUrl":"https://doi.org/10.1038/s41598-025-99884-y","workflowStages":[]},"version":"v1","identity":"rs-5944049","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5944049","identity":"rs-5944049","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}