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
Fully percutaneous, navigation-assisted cervical pedicle screw instrumentation: technical note and a report of safety and accuracy.
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
introductionCervical pedicle screws provide superior biomechanical stability compared with lateral mass screws, resulting in stronger and more durable constructs. Furthermore, most published reports consist of small retrospective series or feasibility studies, and prospective evidence regarding fully percutaneous navigation-assisted cervical pedicle screw fixation remains scarce. We present a technical note on fully percutaneous cervical pedicle screw instrumentation and report the preliminary radiological and clinical outcomes of our initial case series. MATERIALS AND
methodsData from thirteen consecutive patients and forty-two cervical pedicle screws were prospectively collected between October 2024 and September 2025. The primary outcomes were radiological screw placement accuracy assessed using the Bredow classification, the need for screw revision, and clinical safety. Safety was assessed by the occurrence of new postoperative neurological deficits attributable to screw malposition, cerebrospinal fluid (CSF) leak, postoperative infection, vertebral artery injury, and implant-related complications. Additional perioperative safety outcomes, including intraoperative blood loss, surgical time, and length of stay, were recorded. Postoperative pain was additionally assessed using the Visual Analog Scale (VAS).
resultsTraumatic fracture was the most common underlying pathology. Thirty-six screws (85.7%) were classified as Bredow Grades 1-2, while six (14.3%) were Grades 3-5. One of 42 screws (2.4%) required revision. One patient experienced rod dislocation, and another developed occipital neuralgia. No new postoperative neurological deficits attributable to screw malposition, cerebrospinal fluid (CSF) leak, postoperative infection, or vertebral artery injury were observed. Median VAS decreased from 7 preoperatively to 2 at the 30-day follow-up (p = 0.003).
conclusionsFully percutaneous, navigation-assisted cervical pedicle screw fixation appears to be a feasible technique. These preliminary findings should be interpreted with caution given the limited sample size and short follow-up. Larger comparative studies are required to further evaluate the safety, accuracy, and reproducibility of this technique.
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