Background: O-arm and C-arm are commonly used in spine surgery to guide pedicle screw placement. However, concerning the accuracy and efficiency of them, no systematical review and meta-analyses are available to help surgeons make comparisons.
Purposes: This study aims to investigate the accuracy and efficiency of O-arm-navigated versus C-arm-guided pedicle screw placement in thoracic and lumbar spine surgery. It would help surgeons choose the optimal technique for pedicle screw placement.
Patients and methods: A systematic review and meta-analyses were performed after searching the PubMed, Embase, and Cochrane databases to identify all studies that assessed the accuracy and efficiency of navigation coupled with O-arm and conventional C-arm fluoroscopy.
Results: Eight studies were finally recruited in this systematic review, all of which reported pedicle screw placement outcomes related to accuracy or efficiency in both C-arm and O-arm groups. Five studies showed higher screw insertion accuracy in the O-arm group, while one study showed no significant difference. And the pooled results also indicated that the incidence of screw misplacement in the C-arm groups is higher. Moreover, the pooled results from five studies indicated no significant difference in insertion time between C-arm and O-arm.
Conclusions: Navigation coupled with O-arm imaging displayed a lower efficiency outcome in pedicle screw placement compared to conventional C-arm fluoroscopy. However, in terms of accuracy, O-arm navigation had significant advantages in accuracy over conventional C-arm fluoroscopy.
Keywords: C-arm; O-arm; Pedicle screw; Spine surgery.