Comparative analysis of the results of surgical treatment of adult patients with idiopathic scoliosis using intraoperative tomographic navigation

Objective. To perform comparative analysis of the results of pedicle screw fixation using the free-hand method under fluoroscopy control and intraoperative navigation in the surgical treatment of adult patients with idiopathic scoliosis.

Material and Methods. The study included 120 patients (102 women, 18 men) consecutively operated on from January 2020 to December 2024 and divided into two groups chronologically corresponding to the introduction of O-arm navigation technology. Group 1 included 60 patients (53 women, 7 men) in whom screw placement was performed using navigation and intraoperative CT control; Group 2 included 60 patients (49 women, 11 men) in whom screws were placed using the traditional free-hand technique with intraoperative X-ray control (C-arm) and postoperative CT assessment.

Results. The use of O-arm navigation significantly increased the accuracy of screw placement (90.87% vs. 85.57%; p < 0.001) and reduced the malposition rate (9.12% vs. 14.43%). Clinically significant displacements occurred in 1.1% of cases vs. 20.7% (p < 0.001), and the reoperation rate was 1.7% vs. 23.3%. Despite an increase in operative time by 25 minutes, blood loss and length of hospital stay did not differ, and deformity correction was significantly higher (57.76% vs. 47.87%; p < 0.001).

Conclusions. Intraoperative CT navigation improves the safety and effectiveness of spinal deformity surgery. The introduction of O-arm navigation technology significantly reduces the number of revision operations and critical malpositions without significantly changing the time of surgery and the amount of blood loss. 

1. Meng XT, Guan XF, Zhang HL, He SS. Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw placement: a meta-analysis. Neurosurg Rev. 2016;39:385–391. DOI: http://dx.doi.org/10.1007/s10143-015-0679-2

2. Feng W, Wang W, Chen S, Wu K, Wang H. O-arm navigation versus C-arm guidance for pedicle screw placement in spine surgery: a systematic review and meta-analysis. Int Orthop. 2020;44:919–926. DOI: http://dx.doi.org/10.1007/s00264-019-04470-3

3. Кокушин Д.Н, Виссарионов С.В., Баиндурашвили А.Г., Барт В.А. Анализ анатомо-антропометрических параметров позвонков у детей с идиопатическим сколиозом грудной локализации с применением 3D-КТ-навигации. Хирургия позвоночника. 2016;13(1):27–36. [Kokushin DN, Vissarionov SV, Baindurashvili AG, Bart VA. Analysis of anatomical and anthropometric parameters of vertebrae in children with thoracic idiopathic scoliosis using 3D-CT-navigation. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2016;13(1):27–36]. DOI: http://dx.doi.org/10.14531/ss2016.1.27-36 EDN: https://elibrary.ru/VQGEED

4. Кокушин Д.Н, Виссарионов С.В., Баиндурашвили А.Г., Овечкина А.В., Хусаинов Н.О., Познович М.С., Залетина А.В. Применение шаблонов-направителей при хирургическом лечении детей дошкольного возраста с врожденным сколиозом грудной и поясничной локализации. Ортопедия, травматология и восстановительная хирургия детского возраста. 2020;8(3):305–316. [Kokushin DN, Vissarionov SV, Baindurashvili AG, Ovechkina AV, Khusainov NO, Poznovich MS, Zaletina AV. The use of guide templates in the surgical treatment of preschool children with congenital scoliosis of thoracic and lumbar localization. Pediatric traumatology, orthopaedics and reconstructive surgery. 2020;8(3):305–316]. DOI: http://dx.doi.org/10.17816/PTORS42000 EDN: https://elibrary.ru/CZKJQK

5. Tian NF, Huang QS, Zhou P, Zhou Y, Wu RK, Lou Y, Xu HZ. Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur Spine J. 2011;20:846–859. DOI: http://dx.doi.org/10.1007/s00586-010-1577-5

6. Прудникова О.Г., Матвеев Е.А., Стребкова М.С., Евсюков А.В. КТ-навигация в хирургии деформаций позвоночника. Гений ортопедии. 2025;31(6):839–849. [Prudnikova O.G., Matveev E.A., Strebkova M.S., Evsyukov A.V. CT navigation in spinal deformity surgery. Genij Ortopedii. 2025;31(6):839–849]. DOI: http://dx.doi.org/10.18019/1028-4427-2025-31-6-839-849 EDN: https://elibrary.ru/ANWZZD

7. Идиопатический сколиоз: клинические рекомендации. Минздрав России, 2024. [Idiopathic Scoliosis: Clinical guidelines. Ministry of Health of Russia, 2024]. Available on: https://cr.minzdrav.gov.ru/preview-cr/850_1

8. Прудникова О.Г., Матвеев Е.А., Стребкова М.С., Евсюков А.В. Классификация мальпозиций винтов при инструментальной фиксации деформаций позвоночника. Хирургия позвоночника. 2025;22(3):6–17. [Prudnikova O.G., Matveev E.A., Strebkova M.S., Evsyukov A.V. Classification of screw malpositions in instrumental fixation of spinal deformities. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2025;22(3):6–17]. EDN: https://elibrary.ru/QCKEUU DOI: http://dx.doi.org/10.14531/ss2025.3.6-17

9. Прудникова О.Г., Матвеев Е.А., Стребкова М.С. Способ установки опорного винта грудного отдела позвоночника при сколиозе. Патент RU 2862821; заявл. 26.11.25; опубл. 26.05.2026. Бюл. № 15. [Prudnikova OG, Matveev EA, Strebkova MS. Method for installing support screw in thoracic spine for scoliosis. Patent RU 2 862821. Appl. 26.11.2025. Publ. 26.05.2026. Bull 15].

10. Baldwin KD, Kadiyala M, Talwar D, Sankar WN, Flynn JJM, Anari JB. Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis. Spine Deform. 2022;10:19–29. DOI: http://dx.doi.org/10.1007/s43390 021-00385-5

11. Chan A, Parent E, Narvacan K, San C, Lou E. Intraoperative image guidance compared with free-hand methods in adolescent idiopathic scoliosis posterior spinal surgery: a systematic review on screw-related complications and breach rates. Spine J. 2017;17:1215–1229. DOI: http://dx.doi.org/10.1016/j.spinee.2017.04.001

12. Tian W, Zeng C, An Y, Wang C, Liu Y, Li J. Accuracy and postoperative assessment of pedicle screw placement during scoliosis surgery with computer assisted navigation: a meta-analysis. Int J Med Robot. 2017;13. DOI: http://dx.doi.org/10.1002/rcs.1732

13. Meng XT, Guan XF, Zhang HL, He SS. Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw placement: a meta-analysis. Neurosurg Rev. 2016;39:385–391. DOI: http://dx.doi.org/10.1007/s10143-015-0679-2

14. Oba H, Uehara M, Ikegami S, Hatakenaka T, Kamanaka T, Miyaoka Y, Kurogouchi D, Fukuzawa T, Mimura T, Tanikawa Y, Koseki M, Ohba T, Takahashi J. Tips and pitfalls to improve accuracy and reduce radiation exposure in intraoperative CT navigation for pediatric scoliosis: a systematic review. Spine J. 2023;23:183–196. DOI: http://dx.doi.org/10.1016/j.spinee.2022.09.004

15. Ansorge A, Sarwahi V, Bazin L, Vazquez O, De Marco G, Dayer R. Accuracy and safety of pedicle screw placement for treating adolescent idiopathic scoliosis: a narrative review comparing available techniques. Diagnostics (Basel). 2023;13:2402. DOI: http://dx.doi.org/10.3390/diagnostics13142402

16. Aoude AA, Fortin M, Figueiredo R, Jarzem P, Quellet J, Weber MH. Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review. Eur Spine J. 2015;24:990–1004. DOI: http://dx.doi.org/10.1007/s00586-015-3853-x

17. Chan A, Parent E, Wong J, Narvacan K, San C, Lou E. Does image guidance decrease pedicle screw-related complications in surgical treatment of adolescent idiopathic scoliosis: a systematic review update and meta-analysis. Eur Spine J. 2020;29:694–716. DOI: http://dx.doi.org/10.1007/s00586-019-06219-3