Feasibility of Intraoperative Computed Tomography Navigation System for Pedicle Screw Insertion of the Thoracolumbar Spine

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Study Design:

A retrospective analysis of feasibility of intraoperative computed tomography (iCT) navigation for pedicle screw insertion of the thoracolumbar spine.


This study assessed the feasibility of an iCT navigation system by evaluating the screw insertion time, screw revision time, and learning curve of the iCT surgical team in patients who underwent thoracolumbar pedicle screw surgery using this navigation system.

Summary of Background Data:

The iCT navigation system has been reported to improve the accuracy and safety of pedicle screw insertion. However, the assessment of the feasibility of spinal instrumentation guided by iCT navigation system is limited.

Materials and Methods:

From the time iCT navigation system was set-up to a period covering 16 months, consecutive patients who underwent thoracic or lumbar spinal pedicle screw surgery were enrolled. The screw insertion and screw revision times were estimated using the system’s automatic time recording between the iCT scans. The insertion time per screw of the first 50 patients not requiring screw revision was also analyzed to evaluate the learning curve of the iCT surgical team.


There were 178 patients with a total of 932 pedicle screws. The cortical breach rate was 3.2% and the screw revision rate was 1.4%. The insertion time per screw was 10.2±6.3 minutes and the screw revision time was 13.8±9.9 minutes. The learning curve of the iCT surgical team for pedicle screw insertion guided by this navigation system was not steep, and experience from <10 patients was adequate to provide familiarity with this system.


The iCT navigation system is clinically feasible for thoracolumbar pedicle screw surgery. It provides high-level safety and accuracy, as well as ease of screw revision when required.

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