ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
First experience with a novel image guidance technology for posterior pedicle screw fixation: A cadaveric study on 2D/3D registration-based spine surgery.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeMinimally invasive pedicle screw insertion relies on imaging techniques due to limited anatomical visualization. A potential solution for intraoperative 3D guidance is using 2D/3D registration algorithms, which align intraoperative 2D X-rays with preoperatively acquired 3D datasets. This study aimed to evaluate the application of a novel 2D/3D image guidance software in posterior fixation with pedicle screws regarding accuracy, speed, and radiation exposure in a realistic clinical setting.
methodsFour human cadavers were instrumented with a total of 80 pedicle screws (from T8 to L5) by eight surgeons using 2D/3D image guidance. The surgeons, with varying levels of experience in spine surgery and navigation, utilized the software for the first time. Before the procedures, they underwent a structured one-hour training session. Accuracy, time parameters, and radiation exposure during pedicle screw insertion were assessed.
resultsAll K-wires were inserted correctly, demonstrating precise wire placement, regardless of the surgeons' experience. For pedicle screw placement, the 2D/3D image guidance achieved high accuracy of 95.0%, with no superior or inferior perforations. The mean time for each pedicle screw placement was 7.62 ± 2.83 min, with an average radiation exposure of 1.24 µSv per pedicle screw for the surgeon.
conclusionThe use of 2D/3D image guidance in this study demonstrated high precision in the placement of K-wires and pedicle screws. Consequently, 2D/3D image guidance presents a promising tool for both experienced and inexperienced users, facilitating precise 3D guidance of pedicle screws with a standard 2D C-arm.
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