The accuracy of pedicle screw placement in thoracolumbar fractures: A comparative study of automated cone-beam CT-based navigation and conventional fluoroscopy

Abstract

Introduction Pedicle screw fixation is a standard technique for stabilizing unstable thoracolumbar fractures. Mobile cone-beam CT (CBCT) systems with robotic image acquisition enable automated navigation workflows, but clinical data in spine trauma remain limited. Research question To compare pedicle screw accuracy and perioperative outcomes between automated CBCT-based navigation and conventional fluoroscopy in thoracolumbar fracture fixation. Material and methods This single-centre retrospective cohort study included adults with unstable thoracolumbar spine injuries undergoing pedicle screw fixation during a 5.5-year period. In the CBCT group, intraoperative 3D navigation was performed using an automated CBCT system. Perioperative and postoperative variables were recorded, and screw placement was assessed using the Gertzbein–Robbins classification. Outcomes were compared between groups. Results Forty-six patients were included: 25 treated with automated CBCT-based navigation and 21 with conventional fluoroscopy. Among 313 evaluable screws, 96.8% were graded Gertzbein–Robbins A or B, and no grade E breaches were observed. In CBCT screws, no grade D or E breach occurred, and no screw-related early reoperations were required. Total operative time was longer with CBCT (154 vs. 119 min; p = 0.018), and blood loss was numerically higher (259 vs. 179 mL; p = 0.272), although operative time and blood loss per pedicle screw did not differ significantly between groups. Length of hospital stay and early clinical outcomes were comparable. Conclusion Automated CBCT-based intraoperative 3D navigation provides high pedicle screw accuracy and comparable perioperative outcomes. CBCT-based navigation enables real-time 3D visualization and intraoperative verification, supporting its role as a reliable imaging modality in spine trauma surgery.