Intraoperative three-dimensional navigation for pedicle screw placement

The mobile SIREMOBIL iso-C-3D C-arm (Siemens, Erlangen, Germany) is the first device permitting intraoperative, three-dimensional representation of bone structures. A high-resolution, isotropic 3D data cube in the isocenter with sides of approximately 12 cm is calculated simultaneously. The SIREMOBIL Iso-C-3D is linked to the navigation system. This makes it possible to transfer the generated 3D data directly to the linked navigation system without the need for surgeon-dependent registration. In this prospective clinical trial, we evaluated the accuracy of pedicle screw placement using this device. In 61 patients, a total of 302 pedicle screws were placed. Only in five cases (1.7%) were misplacements of >2 mm shown in postoperative control CT. The average fluoroscopy time was 1.28 +/- 0.56 min, and the average operative duration was 103.26 +/- 23.3 min. There were no postoperative neurological complications in any of the 30 patients. From these data, we conclude that Iso-C-3D navigation is a very accurate method for the placement of pedicle screws.