Accurate Screw Research Articles

Robot-assisted versus navigated transpedicular spine fusion: A comparative study.

The aim of this study was to compare the intraoperative and postoperative outcomes between a robot-assisted versus a navigated transpedicular fusion technique. This retrospective analysis included patients who underwent transpedicular posterior fusion of the spine due to trauma, pyogenic spondylodiscitis and osteoporosis. Surgery was done either with a robot-assisted or a percutaneous navigated transpedicular fusion technique. The outcome analysis included the duration of surgery, the radiation exposure, the postoperative screw position and complications. A total of 60 patients were operated and 491 screws were analysed. No statistical difference was seen in the applied cumulative effective radiation dose per patient. The radiological assessment revealed a more accurate screw placement with robot assistance. A learning curve could be observed in robot-assisted fusion. Robot-assisted and navigated transpedicular fusion techniques are both effective and safe. Robot-assisted transpedicular spine fusion goes along with higher placement accuracy but its implementation needs an adequate learning curve.

Application of the cortical bone trajectory technique in posterior lumbar fixation.

The cortical bone trajectory (CBT) is a novel technique in lumbar fixation and fusion. The unique caudocephalad and medial-lateral screw trajectories endow it with excellent screw purchase for vertebral fixation via a minimally invasive method. The combined use of CBT screws with transforaminal or posterior lumbar interbody fusion can treat a variety of lumbar diseases, including spondylolisthesis or stenosis, and can also be used as a remedy for revision surgery when the pedicle screw fails. CBT has obvious advantages in terms of surgical trauma, postoperative recovery, prevention and treatment of adjacent vertebral disease, and the surgical treatment of obese and osteoporosis patients. However, the concept of CBT internal fixation technology appeared relatively recently; consequently, there are few relevant clinical studies, and the long-term clinical efficacy and related complications have not been reported. Therefore, large sample and prospective studies are needed to further reveal the long-term complications and fusion rate. As a supplement to the traditional pedicle trajectory fixation technique, the CBT technique is a good choice for the treatment of lumbar diseases with accurate screw placement and strict indications and is thus deserving of clinical recommendation.

Robot-assisted cannulated compression screw internal fixation for treatment of femoral neck fracture in children: A case series of ten patients.

To investigate the safety and efficacy of robot-assisted cannulated compression screw internal fixation in the treatment of femoral neck fracture in children. We retrospectively reviewed the data of ten children with femoral neck fractures treated by robot-assisted internal fixation from January 2020 to June 2021. The clinical and radiological characteristics, operation duration, and fluoroscopy frequency of robot-assisted screws placement together with the complications and function were evaluated. At the 12-month follow-up, the hip joint function was evaluated using the Ratliff classification. Ten children, six boys and four girls, aged 4-14 years were included. There were eight type II and three type III femoral neck fractures using the Delbet classification. In the process of robot-assisted internal fixation, the median of fluoroscopy frequency was 22 times and the median of operation duration was 47 min. The median of screw parallelism was 1.33° and 0.66° on the anteroposterior and lateral x-ray films, and the median of screw distribution was 41.86% and 44.93% on the anteroposterior and lateral x-ray films, respectively. At the 12-month follow-up, there were two cases of femoral head necrosis, and fracture healing was achieved in all patients, of which eight fractures were excellent and three were good by the Ratliff function classification. The application of robot-assisted cannulated compression screw internal fixation could help us achieve more safe and accurate screw placement, as well as a good treatment effect for children's femoral neck fractures. Level IV. retrospective case series.

Implications of navigation in thoracolumbar pedicle screw placement on screw accuracy and screw diameter/pedicle width ratio

IntroductionThere is ample evidence that higher accuracy can be achieved in thoracolumbar pedicle screw placement by using spinal navigation. Still, to date, the evidence regarding the influence of the use of navigation on the screw diameter to pedicle width ratio remains limited. Research questionThe aim of this study was to investigate the implications of navigation in thoracolumbar pedicle screw placement not only on screw accuracy, but on the screw diameter to pedicle width ratio as well. Material and methodsIn this single-center single-surgeon study, 45 Patients undergoing navigated thoracolumbar pedicle screw placement were prospectively included. The results were compared with a matched comparison group of patients in which screw placement was performed under fluoroscopic guidance. The screw accuracy and the screw diameter to pedicle width ratio of every screw were compared between the groups. ResultsScrew accuracy was significantly higher in the navigation group compared to the fluoroscopic guidance group, alongside with a significant increase of the screw diameter to pedicle width ratio by approximately 10%. In addition, both the intraoperative radiation dose and the operating time tended to be lower in the study group. ConclusionThis study was able to show that navigated thoracolumbar pedicle screw placement not only increases the accuracy of screw placement but also facilitates the selection of the adequate screw sizes, which according to the literature has positive effects on fixation strength. Meanwhile, the use of navigation did not negatively affect the time needed for surgery or the patient's intraoperative exposure to radiation.

Increasing the dynamic accuracy of ball screw drives with quasi-sliding-mode (qSMC) position control

To increase the dynamics of ball screw drives, a nonlinear position controller based on sliding-mode control is presented along with its parameterization to ensure robust stability. The controller is validated experimentally on a ball screw axis and shown to increase the controller bandwidth from 8 Hz to 15.9 Hz in comparison to proportional (P) position control with feedforward. The mean absolute tracking error under high performance cutting forces is reduced by 24%. Under variation of the model parameters by 20%, the controller shows excellent robust performance with only 2.7% degradation of the tracking error.

Pedicle screw accuracy in clinical utilization of minimally invasive intra-operative CT navigated robotic spine surgery for single versus multi-level surgery

Pedicle screw accuracy in clinical utilization of minimally invasive intra-operative CT navigated robotic spine surgery for single versus multi-level surgery

Prospective comparison on 100 patients between O-arm and surgivisio for pedicle screw accuracy and radiation exposure

Prospective comparison on 100 patients between O-arm and surgivisio for pedicle screw accuracy and radiation exposure

Cirq® robotic assistance for thoracolumbar pedicle screw placement – feasibility, accuracy, and safety

IntroductionNew technologies providing higher degree of precision, less risk for damage and less harmful exposure to radiation are necessary for correct transpedicular screw trajectory, but their efficacy should be evaluated. Research QuestionEvaluate the feasibility, accuracy and safety of Brainlab Cirq® navigated robotic arm assistance for pedicle screw placement in comparison to fluoroscopic guidance. Material and MethodsGroup I “Cirq® robotic-assisted group” – 97 screws in 21 prospectively analyzed patients. Group II “Fluoroscopy-guided group” – 98 screws in 16 consecutive patients analyzed retrospectively. Comparative evaluations included screw accuracy on Gertzbein-Robbins’s scale and fluoroscopy time. Time per screw and subjective mental workload (MWL) measured with the raw NASA task load index tool were assessed for Group I. Results195 screws were evaluated. Group I: 93 screws grade A (95.88%); 4 grade B (4.12%). In Group II, 87 screws grade A (88.78%); 9 grade B (9.18%); 1 grade C (1.02%); 1 grade D (1.02%). While the screws placed using the Cirq® system were more accurate overall, there was no statistical significance between the two groups, p=0.3714. There was no significant difference in operation length or radiation exposure between the two groups, however with the Cirq® system the radiation exposure for the surgeon was limited. Reduction in time per screw (p<0.0001) and in the MWL (p=0.0024) correlated with the surgeon’s experience with Cirq®. Discussion and ConclusionThe initial experience suggests that navigated, passive robotic arm assistance is feasible, at least as accurate as fluoroscopic guidance, and safe for pedicle screw placement.

Cirq Robotic Assistance for Thoracolumbar Pedicle Screw Placement: Overcoming the Disadvantages of Minimally Invasive Spine Surgery.

Various minimally invasive spine surgery (MISS) techniques have been developed with the goal of reducing approach-related soft-tissue trauma and its associated complications. However, there is still a debate on some of the potential drawbacks of MISS techniques, such as their longer operating times and increased intraoperative radiation. A solution to these disadvantages could be the implementation of new technologies, such as computer-assisted navigation (CAN) and surgical robotics. We compare the standard fluoroscopy MISS technique with our experience with time per screw and X-ray exposure for pedicle screw placement using the Brainlab Cirq passive robotic arm assistance coupled with the Brainlab Curve navigation system. In the Cirq robot-assisted group (Group I), 109 screws were placed in 24 prospectively analyzed patients. In the fluoroscopy-guided group, 108 screws inserted into 20 consecutive patients were analyzed retrospectively (Group II). The duration of surgery, the time to place one screw, the X-ray exposition, and the pedicle screw accuracy for each patient were recorded and reviewed. In total, 217 screws were analyzed. The treated levels ranged from T10 to S1. In Group I, 104 screws were grade A (95.4%) and five were grade B (4.6%). In Group II, 96 screws were grade A (88.89%); ten were grade B (9.26%); one was grade C (0.93%), and one was grade D (0.93%). While the screws placed by using the Cirq system were more accurate overall, there was no statistical significance when the two groups were compared, p=0.3724. There was no significant difference in radiation exposure between the two groups, p=0.5482; however the radiation exposure for the surgeon was very limited with the Cirq system. There was a significant reduction in the operation length (p=0.0183) and the time per screw (p<0.0001) for Group I. The CAN systems and emerging robotic platforms have the potential to diminish the main disadvantages of MISS techniques-longer operation times and X-ray exposure, at least for the surgical team.

ACCURACY AND RELIABILITY OF FREE HAND C7 PEDICLE SCREWS IN POSTERIOR CERVICAL FIXATION

Objective: Lateral mass screws are widely used for cervical vertebra fixation. The lateral mass of the C7 vertebra is small in volume. Therefore, the potential risks of biomechanical failure of screws applied to lateral masses makes the pedicle screw a better option for the C7 level. Although cervical pedicle screw application is thought to be a difficult and risky procedure in terms of neurovascular injury, it is actually a very safe method since the a.vertebralis does not pass through the C7 vertebra. In this study, we aimed to evaluate the technical details and screw accuracy of free hand pedicle screw placement in C7 vertebra fixation. Materials and Methods: Forty-six patients (92 screws) who underwent free hand pedicle screw placement in the C7 vertebra due to various cervical pathologies were included in this study. Measurements were made on routinely obtained preoperative and postoperative CT images. Screw malpositions and screw application angles, such as the pedicle screw causing a cortical violation in the bone structure or its progression towards the spinal canal and vertebral foramen, were carefully examined. Results: Postoperative CT imaging revealed grade 2a cortical violation in 6 screws, grade 2b cortical violation in 1 screw, and grade 3 malposition in one screw. Radiculopathy was seen postoperatively in one patient. No vascular injury was observed postoperatively in any patients. Conclusions: Placing a free hand pedicle screw in the C7 vertebra is a successful and safe method. At this point, we see the C7 pedicle screw application as a starting point in the learning curve for the entire cervical region pedicle screwing.

Computed Tomography-Based Occipital Condyle Morphometric Analysis in the Turkish Population: A Trajectory Analysis for Optimal Screw Selection.

To provide a comprehensive analysis for accurate screw size selection and insertion angle during surgical procedures. In this retrospective study, a total of 120 patients participated, resulting in the analysis of 240 occipital condyles using coronal, sagittal, and axial planes on CT scans. Statistical evaluation was performed using the Wilcoxon rank-sum test, with p < 0.05 considered statistically significant. The mean sagittal length and height were measured at 17.2 ± 1.7 mm and 9.1 ± 1.5 mm, respectively. The average condyle angle, a crucial factor for screw insertion, was assessed at 38.0 ± 5.5 mm in length, 19.6 ± 2.6 mm in width, and 9.5 ± 1.0 mm in height. Condyle height in the anterior and posterior hypoglossal canals was measured at 10.8 ± 1.4 mm and 9.0 ± 1.4 mm, respectively. Screw angle and condyle width were statistically smaller in females compared to the male population. The OC is a significant anatomical structure in the craniovertebral junction, playing a crucial role in stability. The obtained morphological values are applicable to the Turkish population and offer statistically significant findings for preoperative planning involving occipital condyle screw instrumentation.

Single-Position Oblique Lumbar Interbody Fusion and Percutaneous Pedicle Screw Fixation under O-Arm Navigation: A Retrospective Comparative Study

The insertion of pedicle screws in the lateral position without a position change has been reported. We completed a retrospective comparison of the radiologic and clinical outcomes of 36 patients who underwent either single-position oblique lateral lumbar interbody fusion (SP-OLIF) using the O-arm (36 cases) or conventional OLIF (C-OLIF) using the C-arm (20 cases) for L2-5 single-level lumbar degenerative diseases. Radiological parameters were analyzed, including screw accuracy (Gertzbein-Robbins classification system; GRS), segmental instability, and fusion status. Screw misplacement was defined as a discrepancy of ≥2 mm. Clinical outcomes, including visual analog scale, Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), and postoperative complications, were assessed. The spinal fusion rate was not different between the SP-OLIF and C-OLIF groups one year after surgery (p = 0.536). The ODI score was lower (p = 0.015) in the SP-OLIF than the C-OLIF group. Physical (p = 0.000) and mental component summaries (p = 0.000) of the SF-36 were significantly higher in the SP-OLIF group. Overall complication rates, including revision, surgical site infection, ipsilateral weakness, and radicular pain/numbness, were not significantly different. SP-OLIF using the O-arm procedure is feasible, with acceptable accuracy, fusion rate, and complication rate. This may be an alternative to conventional two-stage operations.

Technique for Validation of Intraoperative Navigation in Minimally Invasive Spine Surgery.

Intraoperative 3-dimensional navigation is an enabling technology that has quickly become a commonplace in minimally invasive spine surgery (MISS). It provides a useful adjunct for percutaneous pedicle screw fixation. Although navigation is associated with many benefits, including improvement in overall screw accuracy, navigation errors can lead to misplaced instrumentation and potential complications or revision surgery. It is difficult to confirm navigation accuracy without a distant reference point. To describe a simple technique for validating navigation accuracy in the operating room during MISS. The operating room is set up in a standard fashion for MISS with intraoperative cross-sectional imaging available. A 16-gauge needle is placed within the bone of the spinous process before intraoperative cross-sectional imaging. The entry level is chosen such that the space between the reference array and the needle encompasses the surgical construct. Before placing each pedicle screw, accuracy is verified by placing the navigation probe over the needle. This technique has identified navigation inaccuracy and led to repeat cross-sectional imaging. No screws have been misplaced in the senior author's cases since adopting this technique, and there have been no complications attributable to the technique. Navigation inaccuracy is an inherent risk in MISS, but the described technique may mitigate this risk by providing a stable reference point.

Intraoperative computed tomography-guided navigation for implant anchorage in spine surgery

Improved accuracy of spinal instrumentation with the use of intraoperative CT (iCT). All types of posterior spinal instrumentation. None. After fixation of the spinal clamp, an intraoperative CT (iCT) is performed. The image data set can then be used for navigation of the spinal implants. The arrangement of the devices, positioning of the patient, and the exact fixation of the clamp depend on the operation technique and the anatomical region. Ahigh level of standardization is necessary for clinical success. In general, the utilization of drill guides over the use of awls and Yamshidi needles is strongly recommended. Thereby the risk of segmental vertebral rotation, especially in multisegmental instrumentation, will be reduced. The postoperative management depends on the type of surgery and is not influenced by the use of navigation with iCT. In our patient group of the first 200 surgeries with iCT (AIRO, Brainlab AG, Munich, Germany), we performed 34% cervical instrumentations, 31% percutaneous screw insertions, and 35% multisegmental open procedures including the sacrum or ilium. Two surgeries had to be converted to conventional technique due to technical problems. One misplaced S2/Ala/ilium screw had to be corrected in revision surgery. The infection rate was 2.5% and was not increased compared to conventional procedures. In the literature, asignificant reduction of radiation exposure was shown, when iCT and navigation were used. Also, in longer surgical cases the operation time could be reduced. In comparison with 3D C‑arm imaging, the image quality and screw accuracy is improved by iCT. Due to the possibility of 3D intraoperative implant control, the number of revision cases can be reduced.

Development of a Pedicle Screw Fixation Simulation Model for Surgical Training Using a 3-Dimensional Printer

Training surgeons in pedicle screw fixation (PSF) techniques during actual surgery is limited because of patient safety, complications, and surgical efficiency issues. Recent technical developments are leading the world to an era of personalized three-dimensional (3D) printing. This study aimed to evaluate the educational effect of using a 3D-printed spine model to train beginners in PSF techniques to improve screw accuracy and procedure time. Computed tomography (CT) scan data were used in a 3D printer to produce a life-size lumbar spine replica of L1-3 vertebrae. Four residents performed PSF thrice. Each resident performed 18 screw fixations on both sides (6 screws per trial). The time to complete the procedure and pedicle violation was recorded. The average time for the 3 procedures was 42.1±2.9 minutes, 38.8±3.3 minutes, and 32.1±2.5 minutes, respectively. Furthermore, the average pedicle screw score for the 3 procedures was 13.0±0.8, 14.5±0.6, and 16.0±0.8, respectively. As the trial was repeated, the procedure time decreased and the accuracy of screw fixation tended to be more accurate. It was possible to decrease the procedure time and increase accuracy through repeated training using the 3D-printed spine model. By implementing a 3Dprinted spine model based on the patient's actual CT data, surgeons can perform simulation surgery before the actual surgery. Therefore, this technology can be useful in educating residents to improve their surgical skills.

O-Arm Accuracy and Radiation Exposure in Adult Deformity Surgery

In long thoracolumbar deformity surgery, accurate screw positioning is critical for spinal stability. We assessed pedicle and pelvic screw accuracy and radiation exposure in patients undergoing long thoracolumbar deformity fusion surgery (≥4 levels) involving 3-dimensional fluoroscopy (O-Arm/Stealth) navigation. In this retrospective single-center cohort study, all patients aged >18years who underwent fusion in 2016-2018 were reviewed. O-Arm images were assessed for screw accuracy. Effective radiation doses were calculated. The primary outcome was pedicle screw accuracy (Heary grade). Secondary outcomes were pelvic fixation screw accuracy, radiation exposure, and screw-related perioperative and postoperative complications or revision surgery within 3years. Of 1477 pedicle screws placed in 91 patients (mean 16.41±5.6 screws/patient), 1208 pedicle screws (81.8%) could be evaluated by 3-dimensional imaging after placement. Heary Grade I placement was achieved in 1150 screws (95.2%), Grade II in 47 (3.9%), Grade III in 10 (0.82%), Grade IV in 1 (0.08%), and Grade V in 0; Grade III-V were replaced intraoperatively. One of 60 (1.6%) sacroiliac screws placed showed medial cortical breach and was replaced. The average O-Arm-related effective dose was 29.54±14.29mSv and effective dose/spin was 8.25±2.65mSv. No postoperative neurological worsening, vascular injuries, or revision surgeries for screw misplacement were recorded. With effective radiation doses similar to those in interventional neuroendovascular procedures, the use of O-Arm in multilevel complex deformity surgery resulted in high screw accuracy, no need for surgical revision because of screw malposition, less additional imaging, and no radiation exposure for the surgical team.

R2 advances in robotic-assisted spine surgery: comparative analysis of options, future directions, and bibliometric analysis of the literature

Spine surgery has undergone rapid advancements over the past several decades with the emergence of robotic and minimally invasive surgery (MIS). While conventional MIS spine surgery has had relative success, its complication profile has warranted continued efforts to improve clinical outcomes. We discuss the functional, clinical, and financial aspects of four robotic options for spinal pathologies, namely ROSA, Mazor X, Da Vinci, and ExcelsiusGPS, and conduct a bibliometric analysis to better understand current trends and applications of these robots as the field of robotic spine surgery continues to grow. An extensive search of English-language published literature on robotic-assisted spinal surgery was performed in Elsevier's Scopus database. A bibliometric analysis was then performed on the top 100 most cited papers. The search yielded articles regarding robotic-assisted spine surgery application, limitations, and functional outcomes secondary to spine pathology. Accuracy analyses of 1733 screw placements were reviewed. The top 100 papers were published between 1992 and 2020, with a significant increase from 2015 onwards. The top publishing institution was John Hopkins University (n = 8). The top contributing author was Dr. Isador H. Lieberman (n = 6). The USA (n = 34) had the most articles on robotic spinal surgery, followed by Germany (n = 12). This review examines robotic applications in spine surgery, including four available options: ROSA, Mazor X, Da Vinci, and ExcelsiusGPS. Publication output over time, surgical outcomes, screw accuracy, and cost-effectiveness of these technologies have been investigated here. Certain robots have functional, clinical, and financial differences worth noting. Given the dearth of existing literature reporting postoperative complications and long-term comparative outcomes, there is a clear need for further studies on this matter.

TiRobot‑assisted versus conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation for pelvic ring injuries: a meta‑analysis

BackgroundThe TiRobot is the only robot that has been reported in the literature for posterior pelvic injuries. We aim to compare TiRobot-assisted pelvic screw fixation with the conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation.MethodsWe conducted a meta-analysis to identify studies involving TiRobot‑assisted versus conventional percutaneous sacroiliac screw fixation for pelvic ring injuries in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and WanFang database, up to April 2022. The following keywords were used: “TiRobot,” “robot,” “robotic,” “pelvic fracture,” “screw fixation,” “percutaneous,” and “pelvic ring injury.” Pooled effects of this meta-analysis were calculated using STATA SE version 15.0.ResultsCompared with conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation, TiRobot will result in less radiation exposure time of screw implantation (P = 0.000), less frequency of intraoperative fluoroscopy (P = 0.000), fewer guide wire attempts (P = 0.000), less intraoperative blood loss (P = 0.005), better screw accuracy (P = 0.011), better Majeed score (P = 0.031), and higher overall excellent and good rates of Majeed score (P = 0.018). However, there were no significant differences in terms of operative time (P = 0.055), fracture healing time (P = 0.365), and overall excellent and good rate of reduction accuracy (P = 0.426) between the two groups.ConclusionTiRobot-assisted fixation has less intraoperative fluoroscopy and intraoperative blood loss, superior screw accuracy, and Majeed score compared with conventional percutaneous sacroiliac screw fixation. TiRobot has no significant effect on operative time, fracture healing time, and reduction accuracy. Given the relevant possible biases in our meta-analysis, we required more adequately powered and better-designed RCT studies with long-term follow-up to reach a firmer conclusion.

A Retrospective Analysis of Pedicle Screw Placement Accuracy Using the ExcelsiusGPS Robotic Guidance System: Case Series.

Robotic guidance has become widespread in spine surgery. Although the intent is improved screw placement, further system-specific data are required to substantiate this intention for pedicle screws in spinal stabilization constructs. To determine the accuracy of pedicle screws placed with the aid of a robot in a cohort of patients immediately after the adoption of the robot-assisted surgery technique. A retrospective, Institutional Review Board-approved study was performed on the first 100 patients at a single facility, who had undergone spinal surgeries with the use of robotic techniques. Pedicle screw accuracy was graded using the Gertzbein-Robbins Scale based on pedicle wall breach, with grade A representing 0 mm breach and successive grades increasing breach thresholds by 2 mm increments. Preoperative and postoperative computed tomography scans were also used to assess offsets between the objective plan and true screw placements. A total of 326 screws were analyzed among 72 patients with sufficient imaging data. Ages ranged from 21 to 84 years. The total accuracy rate based on the Gertzbein-Robbins Scale was 97.5%, and the rate for each grade is as follows: A, 82%; B, 15.5%; C, 1.5%; D, 1%; and E, 0. The average tip offset was 1.9 mm, the average tail offset was 2.0 mm, and the average angular offset was 2.6°. Robotic-assisted surgery allowed for accurate implantation of pedicle screws on immediate adoption of this technique. There were no complications attributable to the robotic technique, and no hardware revisions were required.

Application of navigation in the fractured spine

Computer navigation is used in patients with spine fractures to optimize the accuracy of pedicle screws and thereby reduce intra- and postoperative complications, such as injuries to vessels, nerves and accompanying structures. In addition, the ideal screw length and diameter for each pedicle can be detected to ensure optimal stability. Intraoperative navigation is suitable for the treatment of spine fractures, which require dorsal stabilization or fusion. It is primarily used for dorsal procedures ranging from the cervical to lumbar/sacral spine. Computer navigation relies on rigid fixation of the dynamic reference base (DRB) at the spinous process. Failure of DRB fixation is the major contraindication for navigation in the spine. After acquisition of an intraoperative three-dimensional (3D) scan, adigital relation between the anatomy and the 3D scan is established with the navigation system and its infrared camera. Pedicle screws are planned percutaneously with acalibrated pointer. In the next step K‑wires (or screws) are implanted after the pedicles are drilled with acalibrated drill guide. After implantation, an additional 3D scan is performed to verify accurate K‑wire placement. Postoperative management does not differ compared to nonnavigated procedures. Intraoperative navigation in combination with modern imaging systems leads to very high accuracy for pedicle screws. Immediate intraoperative control of K‑wires as well as screws and fracture reduction can avoid revision surgery. Image guidance can reduce radiation exposure for the surgical team.