O-Arm Vs Surgivisio for Pedicle Screw Insertion: A Prospective Study on Screw Accuracy and Irradiation on 100 Patients

<h3>Background</h3> Computerized navigation improves the accuracy of spine procedures. However, intraoperative imaging is plagued by ionizing irradiation and its cancer risk. Advanced technologies attempt to optimize the radiation dose. The goal of this study was to compare radiation exposure and screw accuracy of O-arm navigation and the Surgivisio device (SD) in pedicle screw insertion. <h3>Methods</h3> All patients operated on by navigated pedicle screw insertion during a 19-month period were prospectively included in 2 spine centers: the first with the O-arm and the second with the SD. Demographic, operative, and irradiation data were collected. The accuracy of the screw positioning was assessed using the Heary and Gertzbein classifications. The effective dose in millisievert (mSv) was calculated. <h3>Results</h3> One hundred patients were included, 50 per group. Five hundred and twelve screws were inserted, among them 228 in 120 vertebrae with the O-am and 284 in 145 vertebrae with the SD. Screw accuracy was 99.1% with the O-arm vs 93.3% with the SD (<i>P</i> = 0.07). Operative times were similar, with 145 vs 139 minutes respectively, <i>P</i> = 0.68. The effective dose was significantly higher in the O-arm group, with 5.43 vs 2.70 mSv with the SD (<i>P</i> &lt; 0.01). The effective dose related to 2-dimensional imaging was significantly lower in the O-arm group than in the SD group, with 0.26 vs 1.16 mSv, respectively, <i>P</i> &lt; 0.01, related to a shorter imaging duration (4 vs 109 seconds respectively, <i>P</i> &lt; 0.01). <h3>Conclusions</h3> Accuracy of pedicle screws was higher with the O-arm than with the Surgivisio, but the latter showed less radiation exposure. Despite promising results, improvements in technology should be pursued for ergonomics and surgical safety. <h3>Level of Evidence</h3> 4.