O-arm vs. robotic guidance vs. freehand for pedicle screw placement: Which is most accurate? 5 findings

Written by Laura Dyrda | March 12, 2018 | Print  |

A new study published in Spine compares the accuracy of robotic guidance, O-arms and the freehand technique during spine surgery.


The study covered 84 patients who underwent surgery with 569 implantations of lumbar and thoracic screws. Eleven of the patients — with 64 screws — had placement with robotic assistance; 35 patients — with 191 screws — had O-arm placement; and 48 patients — with 314 screws — had them inserted with lateral fluoroscopy using the freehand technique. Study authors found:


1. There wasn't a statistically significant difference between the three groups in placement accuracy:


• Freehand: 70.4 percent
• O-arm: 69.6 percent
• Robotic guidance: 78.8 percent


2. Screw misplacement was also similar between the groups; around 6.4 percent of the freehand screws, 4.2 percent of the O-arm screws and 4.7 percent of the robotic-guided screws were considered misplaced.


3. The researchers reported similar accuracy rates between the senior spine surgeon and the spine fellow inserting the screws. "Under supervision, spinal fellows might perform equally well to experienced surgeons using new tools," they concluded.


4. Study authors concluded the new technologies didn't alter the screw placement accuracy. However, they advised, "The lack of difference in accuracy does not imply that the above-mentioned techniques have no added advantages."


5. While accuracy is similar between all three methods, other issues such as radiation exposure, fiddle factor and teaching suitability were not reflected in these findings.


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