Use of O-arm Navigation in Percutaneous Pedicle Screw Fixation for Thoracolumbar Fractures in Patients with Ankylosing Spinal Disorders: Reducing Intraoperative Radiation Exposure-A Retrospective Cohort Study

Abstract Introduction: Surgical intervention for thoracolumbar fractures in patients with ankylosing spinal disorders (ASD), such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis, typically requires long-segment fixation, which carries a risk of prolonged radiation exposure. Here, we compared the radiation exposure and accuracy of percutaneous pedicle screw (PPS) fixation guided by O-arm navigation or C-arm fluoroscopy in patients with AS who sustained thoracolumbar fractures. Methods: This retrospective cohort study analyzed 24 patients with AS having thoracolumbar fractures who underwent surgery from July 2015 to September 2022. Patients were divided into two groups: O-arm (11 patients) and C-arm (13 patients). Data collected included patient characteristics, intraoperative fluoroscopic radiation exposure time, and PPS placement accuracy using the Heary and Gertzbein classification. Statistical analyses were performed using the Mann-Whitney U test, paired t-test, and chi-square test. Results: Patient characteristics and PPS accuracy did not differ significantly between groups (O-arm: 88.3%, C-arm: 87.3%). The fluoroscopic radiation exposure time was significantly shorter in the O-arm group (2.5 min) than in the C-arm group (15.7 min, p < 0.001). Conclusion: O-arm navigation significantly reduced the intraoperative radiation exposure for the surgical staff during PPS fixation in patients with AS and thoracolumbar fractures, without compromising the screw placement accuracy.