Comparison of the Safety and Accuracy for C2 Pedicle Screw Placement Among 3 Guided Technologies in Patients With High-Riding Vertebral Arteries

Study designRetrospective study.ObjectiveThis study aims to evaluate and compare the accuracy and safety of 3D-printed navigation templates (3D-PNT), O-arm-based S8 navigation (O-S8), and freehand technology (FT)-assisted C2 pedicle screw (C2PS) placement in patients with high-riding vertebral arteries (HRVAs).Methods130 HRVA patients undergoing upper cervical spine surgery were included and classified based on the use of 3D-PNT, O-S8, or FT. The primary outcome was C2PS placement accuracy. Secondary outcomes included screw placement time, operative time, blood loss, radiation exposure, technical cost, hospital stay, and complications.ResultsThe C2PS placement time, operative time, and fluoroscopy duration in the 3D-PNT group were significantly shorter than those in the other two groups, while the fluoroscopy time for O-S8 was significantly longer than the others. Postoperative VAS and JOA scores significantly improved compared to preoperative levels, with no significant intergroup differences. The accuracy rates (grades 0 + 1) were 92.59% (3D-PNT), 90.38% (O-S8), and 70.17% (FT), with 3D-PNT and O-S8 outperforming FT, though no significant difference in accuracy was found between 3D-PNT and O-S8.ConclusionsBoth 3D-PNT and O-S8 improve the accuracy and safety of C2PS in HRVA patients compared to FT. 3D-PNT demonstrated superior performance in reducing screw placement and fluoroscopy times compared to O-S8. However, the requirement for patient-specific customization and preoperative planning limits its immediate applicability in emergency surgeries.