Navigated Pedicle Screw Placement Research Articles

Evaluating a cutting-edge augmented reality-supported navigation system for spinal instrumentation

ObjectiveDorsal instrumentation using pedicle screws is a standard treatment for multiple spinal pathologies, such as trauma, infection, or degenerative indications. Intraoperative three-dimensional (3D) imaging and navigated pedicle screw placement are used at multiple centers. For the present study, we evaluated a new navigation system enabling augmented reality (AR)-supported pedicle screw placement while integrating navigation cameras into the reference array and drill guide. The present study aimed to evaluate its clinical application regarding safety, efficacy, and accuracy.MethodsA total of 20 patients were operated on between 06/2021 and 01/2022 using the new technique for intraoperative navigation. Intraoperative data with a focus on accuracy and patient safety, including patient outcome, were analyzed. The accuracy of pedicle screw placement was evaluated by intraoperative CT imaging.ResultsA median of 8 (4–18) pedicle screws were placed in each case. Percutaneous instrumentation was performed in 14 patients (70%). The duration of pedicle screw placement (duration scan–scan) was 56 ± 26 (30–107) min. Intraoperative screw revision was necessary for 3 of 180 pedicle screws (1.7%). Intraoperatively, no major complications occurred—one case of delay due to software issues and one case of difficult screw placement were reported.ConclusionThe current study's results could confirm the use of the present AR-supported system for navigated pedicle screw placement for dorsal instrumentation in clinical routine. It provides a reliable and safe tool for 3D imaging-based pedicle screw placement, only requires a minimal intraoperative setup, and provides new opportunities by integrating AR.

Radiation exposure for pedicle screw placement with three different navigation system and imaging combinations in a sawbone model

BackgroundStudies have shown that pedicle screw placement using navigation can potentially reduce radiation exposure of surgical personnel compared to conventional methods. Spinal navigation is based on an interaction of a navigation software and 3D imaging. The 3D image data can be acquired using different imaging modalities such as iCT and CBCT. These imaging modalities vary regarding acquisition technique and field of view. The current literature varies greatly in study design, in form of dose registration, as well as navigation systems and imaging modalities analyzed.Therefore, the aim of this study was a standardized comparison of three navigation and imaging system combinations in an experimental setting in an artificial spine model.MethodsIn this experimental study dorsal instrumentation of the thoracolumbar spine was performed using three imaging/navigation system combinations. The system combinations applied were the iCT/Curve, cCBCT/Pulse and oCBCT/StealthStation. Referencing scans were obtained with each imaging modality and served as basis for the respective navigation system. In each group 10 artificial spine models received bilateral dorsal instrumentation from T11-S1. 2 referencing and control scans were acquired with the CBCTs, since their field of view could only depict up to five vertebrae in one scan. The field of view of the iCT enabled the depiction of T11-S1 in one scan. After instrumentation the region of interest was scanned again for evaluation of the screw position, therefore only one referencing and one control scan were obtained. Two dose meters were installed in a spine bed ventral of L1 and S1. The dose measurements in each location and in total were analyzed for each system combination. Time demand regarding screw placement was also assessed for all system combinations.ResultsThe mean radiation dose in the iCT group measured 1,6 ± 1,1 mGy. In the cCBCT group the mean was 3,6 ± 0,3 mGy and in the oCBCT group 10,3 ± 5,7 mGy were measured. The analysis of variance (ANOVA) showed a significant (p < 0.0001) difference between the three groups. The multiple comparisions by the Kruskall-Wallis test showed no significant difference for the comparison of iCT and cCBCT (p1 = 0,13). Significant differences were found for the direct comparison of iCT and oCBCT (p2 < 0,0001), as well as cCBCT and oCBCT (p3 = 0,02). Statistical analysis showed that significantly (iCT vs. oCBCT p = 0,0434; cCBCT vs. oCBCT p = 0,0083) less time was needed for oCBCT based navigated pedicle screw placement compared to the other system combinations (iCT vs. cCBCT p = 0,871).ConclusionUnder standardized conditions oCBCT navigation demanded twice as much radiation as the cCBCT for the same number of scans, while the radiation exposure measured for the iCT and cCBCT for one scan was comparable. Yet, time effort was significantly less for oCBCT based navigation. However, for transferability into clinical practice additional studies should follow evaluating parameters regarding feasibility and clinical outcome under standardized conditions.

Radiation doses and accuracy of navigated pedicle screw placement in cervical and thoracic spine surgery: a comparison of sliding gantry CT and mobile cone-beam CT in a homogeneous cohort.

Multiple solutions for navigation-guided pedicle screw placement are currently available. Intraoperative imaging techniques are invaluable for spinal surgery, but often there is little attention paid to patient radiation exposure. This study aimed to compare the applied radiation doses of sliding gantry CT (SGCT)- and mobile cone-beam CT (CBCT)-based pedicle screw placement for spinal instrumentation. The authors retrospectively analyzed 183 and 54 patients who underwent SGCT- or standard CBCT-based pedicle screw placement, respectively, for spinal instrumentation at their department between June 2019 and January 2020. SGCT uses an automated radiation dose adjustment. Baseline characteristics, including the number of screws per patient and the number of instrumented levels, did not significantly differ between the two groups. Although the accuracy of screw placement according to Gertzbein-Robbins classification did not differ between the two groups, more screws had to be revised intraoperatively in the CBCT group (SGCT 2.7% vs CBCT 6.0%, p = 0.0036). Mean (± SD) radiation doses for the first (SGCT 484.0 ± 201.1 vs CBCT 687.4 ± 188.5 mGy*cm, p < 0.0001), second (SGCT 515.8 ± 216.3 vs CBCT 658.3 ± 220.1 mGy*cm, p < 0.0001), third (SGCT 531.3 ± 237.5 vs CBCT 641.6 ± 177.3 mGy*cm, p = 0.0140), and total (SGCT 1216.9 ± 699.3 vs CBCT 2000.3 ± 921.0 mGy*cm, p < 0.0001) scans were significantly lower for SGCT. This was also true for radiation doses per scanned level (SGCT 461.9 ± 429.3 vs CBCT 1004.1 ± 905.1 mGy*cm, p < 0.0001) and radiation doses per screw (SGCT 172.6 ± 110.1 vs CBCT 349.6 ± 273.4 mGy*cm, p < 0.0001). The applied radiation doses were significantly lower using SGCT for navigated pedicle screw placement in spinal instrumentation. A modern CT scanner on a sliding gantry leads to lower radiation doses, especially through automated 3D radiation dose adjustment.

Sonification as a reliable alternative to conventional visual surgical navigation

Despite the undeniable advantages of image-guided surgical assistance systems in terms of accuracy, such systems have not yet fully met surgeons’ needs or expectations regarding usability, time efficiency, and their integration into the surgical workflow. On the other hand, perceptual studies have shown that presenting independent but causally correlated information via multimodal feedback involving different sensory modalities can improve task performance. This article investigates an alternative method for computer-assisted surgical navigation, introduces a novel four-DOF sonification methodology for navigated pedicle screw placement, and discusses advanced solutions based on multisensory feedback. The proposed method comprises a novel four-DOF sonification solution for alignment tasks in four degrees of freedom based on frequency modulation synthesis. We compared the resulting accuracy and execution time of the proposed sonification method with visual navigation, which is currently considered the state of the art. We conducted a phantom study in which 17 surgeons executed the pedicle screw placement task in the lumbar spine, guided by either the proposed sonification-based or the traditional visual navigation method. The results demonstrated that the proposed method is as accurate as the state of the art while decreasing the surgeon’s need to focus on visual navigation displays instead of the natural focus on surgical tools and targeted anatomy during task execution.

355 Robotic and Navigated Pedicle Screws Are Safer and More Accurate than Freehand Screws: A Systematic Review and Meta-Analysis

INTRODUCTION: Navigation and robotic pedicle screw placement systems have been developed to improve the accuracy of screw placement. However, the literature comparing the safety and accuracy of robotic and navigated screw placement with freehand screw placement in thoracolumbar spine surgery has been limited. METHODS: PubMed and EMBASE were systematically searched according to PRISMA guidelines. The search included indexed terms and text words from database inception to the date of the search (April 7th, 2022). Only randomized controlled trials comparing robotic assisted or navigated screws with fluoroscopic freehand screws in the thoracolumbar spine were included. Data and estimates were pooled using random-effects meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute risk of bias tool. The main outcome measures were odds ratio estimates for screw accuracy according to the Gertzbein-Robbins scale and relative risk for various complications. RESULTS: A total of 14 papers encompassing 12 randomized controlled trials were identified. The pooled analysis demonstrated that robotic and navigated pedicle screw placement techniques were associated with increased odds of screw accuracy (OR 2.66, 95% CI 1.24-5.72, p = 0.0118). Robotic and navigated screw placement was associated with a lower risk of facet joint violations (RR 0.09, 95% CI 0.02-0.38, p = 0.0011) and major complications (RR 0.31, 95% CI 0.11-0.84, p = 0.0215). No differences were found in nerve root injury (RR 0.50, 95% CI 0.11-2.30, p = 0.3704), return to the operating room for screw revision (RR 0.28, 95% CI 0.07-1.13, p = 0.0744). CONCLUSIONS: These analyses suggest that robotic and navigated screw placement techniques are associated with higher odds of screw accuracy and superior safety profile compared to freehand techniques. Additional randomized controlled trials will be needed to further validate these findings.

The one-stop-shop approach: Navigating lumbar 360-degree instrumentation in a single position.

Treatment strategies of patients suffering from pyogenic spondylodiscitis are a controverse topic. Percutaneous dorsal instrumentation followed by surgical debridement and fusion of the infectious vertebral disc spaces is a common approach for surgical treatment. Technical advances enable spinal navigation for dorsal and lateral instrumentation. This report investigates combined navigated dorsal and lateral instrumentation in a single surgery and positioning for lumbar spondylodiscitis in a pilot series. Patients diagnosed with 1- or 2-level discitis were prospectively enrolled. To enable posterior navigated pedicle screw placement and lateral interbody fusion (LLIF) patients were positioned semi-prone in 45-degree fashion. For spinal referencing, a registration array was attached to the pelvic or spinal process. 3D scans were acquired intraoperatively for registration and implant control. 27 patients suffering from 1- or 2-level spondylodiscitis with a median ASA of 3 (1-4) and a mean BMI of 27.9 ± 4.9 kg/m2 were included. Mean duration of surgery was 146 ± 49 min. Mean blood loss was 367 ± 307 ml. A median of 4 (4-8) pedicle screws were placed for dorsal percutaneous instrumentation with an intraoperative revision rate of 4.0%. LLIF was performed on 31 levels with an intraoperative cage revision rate of 9.7%. Navigated lumbar dorsal and lateral instrumentation in a single operation and positioning is feasible and safe. It enables rapid 360-degree instrumentation in these critically ill patients and potentially reduces overall intraoperative radiation exposure for patient and staff. Compared to purely dorsal approaches it allows for optimal discectomy and fusion while overall incisions and wound size are minimized. Compared to prone LLIF procedures, semi-prone in 45-degree positioning allows for a steep learning curve due to minor changes of familiar anatomy.

Comparison of surgical outcomes of C1-2 fusion surgery between O-arm-assistedoperation and C-arm assisted operation in children with atlantoaxial rotatory fixation.

Placement of the pedicle screw is technically challenging during C1-2 fusion surgery in children and different intraoperative image-guided systems have been developed to reduce the risk of screw malposition. The purpose of the present study was to compare surgical outcomes between C-arm fluoroscopy and O-arm navigated pedicle screw placement in the treatment of atlantoaxial rotatory fixation in children. We retrospectively evaluated charts of all consecutive children with atlantoaxial rotatory fixation who underwent C-arm fluoroscopy or O-arm navigated pedicle screw placement from April 2014 to December 2020. Outcomes including operative time, estimated blood loss (EBL), accuracy of screw placement (Neo's classification) and completed fusion time were evaluated. A total of 340 screws were placed in 85 patients. The accuracy of screw placement of the O-arm group was 97.4%, which was significantly higher than that of the C-arm group (91.8%). Both groups had satisfied bony fusion (100%). Statistical significance (230.0 ± 34.6 ml for the C-arm group and 150.6 ± 47.3 ml for the O-arm group, p < 0.05) was observed with respect to the median blood loss. There were no statistically significant difference (122.0 ± 16.5 min for the C-arm group and 110.0 ± 14.4 min for the O-arm group, p = 0.604) with respect to the median operative time. O-arm-assisted navigation allowed more accurate screw placement and less intraoperative blood loss. Both groups had satisfied bony fusion. O-arm navigation did not prolong the operative time despite the time required for setting and scanning.

Robot-assisted pedicle screw placement

Pedicle screw-based posterior instrumentation of the spine. Instability of the spine due to trauma, infection, degenerative spinal disease or tumor. None. Robot-assisted navigated pedicle screw placement. Early functional mobilization starting on the first postoperative day. Astudy by Lee etal. analyzed the clinical application of the system MazorX Stealth Edition (Medtronic Navigation, Louisville, CO, USA; Medtronic Spine, Memphis, TN, USA) in 186cases with atotal of 1445 pedicle screws [1]. Correct screw positioning was achieved in 1432 pedicle screws (99.1%); six pedicle screws (0.4%) were revised intraoperatively. The mean duration of pedicle screw placement was 6.1 ± 2.3 min. Pojskić etal. published acase series regarding the application of the system Cirq (Brainlab, Munich, Germany) in 13cases with atotal number of 70pedicle screws implanted [2]. Intraoperative imaging showed screw positioning according to the Gertzbein Robbins classification (GR) categoryA in 65screws (92.9%) and GRB in one screw (1.4%). Screw positioning GRD with intraoperative revision was reported in two screws (2.9%). Mean duration of pedicle screw placement was 08:27 ± 06:54 min.

First Clinical Experience with a Novel 3D C-Arm-Based System for Navigated Percutaneous Thoracolumbar Pedicle Screw Placement

Background and Objectives: Navigated pedicle screw placement is becoming increasingly popular, as it has been shown to reduce the rate of screw misplacement. We present our intraoperative workflow and initial experience in terms of safety, efficiency, and clinical feasibility with a novel system for a 3D C-arm cone beam computed-tomography-based navigation of thoracolumbar pedicle screws. Materials and Methods: The first 20 consecutive cases of C-arm cone beam computed-tomography-based percutaneous pedicle screw placement using a novel navigation system were included in this study. Procedural data including screw placement time and patient radiation dose were prospectively collected. Final pedicle screw accuracy was assessed using the Gertzbein–Robbins grading system. Results: In total, 156 screws were placed. The screw accuracy was 94.9%. All the pedicle breaches occurred on the lateral pedicle wall, and none caused clinical complications. On average, a time of 2:42 min was required to place a screw. The mean intraoperative patient radiation exposure was 7.46 mSv. Conclusions: In summary, the investigated combination of C-arm CBCT-based navigation proved to be easy to implement and highly reliable. It facilitates the accurate and efficient percutaneous placement of pedicle screws in the thoracolumbar spine. The careful use of intraoperative imaging maintains the intraoperative radiation exposure to the patient at a moderate level.

Great Expectations with Augmented Reality in Spine Surgery: Hope or Hype?A commentary on the article ‘Operator independent reliability of direct augmented reality navigated pedicle screw placement and rod bending’ by Farshad et al.

In NASSJ, Farshad et al. have reported the results of their cadaveric study wherein they investigated the accuracy and the operator-independent reliability of ‘direct’ augmented reality navigated pedicle screw placement and rod bending [1] Over the past few decades, pedicle screws have become the undisputed choice for spinal instrumentation. The consequences of inaccurate pedicle screw placement can be disastrous – ranging from decreased pull-out strength owing to compromised purchase in the bone to iatrogenic injury to critical neurovascular structures.

Operator independent reliability of direct augmented reality navigated pedicle screw placement and rod bending

BackgroundAR based navigation of spine surgeries may not only provide accurate surgical execution but also operator independency by compensating for potential skill deficits. “Direct” AR-navigation, namely superposing trajectories on anatomy directly, have not been investigated regarding their accuracy and operator's dependence.Purpose of this study was to prove operator independent reliability and accuracy of both AR assisted pedicle screw navigation and AR assisted rod bending in a cadaver setting. MethodsTwo experienced spine surgeons and two biomedical engineers (laymen) performed independently from each other pedicle screw instrumentations from L1-L5 in a total of eight lumbar cadaver specimens (20 screws/operator) using a fluoroscopy-free AR based navigation method. Screw fitting rods from L1 to S2-Ala-Ileum were bent bilaterally using an AR based rod bending navigation method (4 rods/operator). Outcome measures were pedicle perforations, accuracy compared to preoperative plan, registration time, navigation time, total rod bending time and operator's satisfaction for these procedures. Results97.5% of all screws were safely placed (<2 mm perforation), overall mean deviation from planned trajectory was 6.8±3.9°, deviation from planned entry point was 4±2.7 mm, registration time per vertebra was 2:25 min (00:56 to 10:00 min), navigation time per screw was 1:07 min (00:15 to 12:43 min) rod bending time per rod was 4:22 min (02:07 to 10:39 min), operator's satisfaction with AR based screw and rod navigation was 5.38±0.67 (1 to 6, 6 being the best rate). Comparison of surgeons and laymen revealed significant difference in navigation time (1:01 min; 00:15 to 3:00 min vs. 01:37 min; 00:23 to 12:43 min; p = 0.004, respectively) but not in pedicle perforation rate. ConclusionsDirect AR based screw and rod navigation using a surface digitization registration technique is reliable and independent of surgical experience. The accuracy of pedicle screw insertion in the lumbar spine is comparable with the current standard techniques.

Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement in 853 patients and 6733 screws

PurposeMultiple solutions for navigation-guided pedicle screw placement are available. However, the efficiency with regard to clinical and resource implications has not yet been analyzed.The present study’s aim was to analyze whether an operating room sliding gantry CT (ORCT)-based approach for spinal instrumentation is more efficient than a mobile cone-beam CT (CBCT)-based approach.MethodsThis cohort study included a random sample of 853 patients who underwent spinal instrumentation using ORCT-based or CBCT-based pedicle screw placement due to tumor, degenerative, trauma, infection, or deformity disorders between November 2015 and January 2020.ResultsMore screws had to be revised intraoperatively in the CBCT group due to insufficient placement (ORCT: 98, 2.8% vs. CBCT: 128, 4.0%; p = 0.0081). The mean time of patients inside the OR (Interval 5 Entry–Exit) was significantly shorter for the ORCT group (ORCT: mean, [95% CI] 256.0, [247.8, 264.3] min, CBCT: 283.0, [274.4, 291.5] min; p < 0.0001) based on shorter times for Interval 2 Positioning—Incision (ORCT: 18.8, [18.1, 19.9] min, CBCT: 33.6, [32.2, 35.5] min; p < 0.0001) and Interval 4 Suture—Exit (ORCT: 24.3, [23.6, 26.1] min, CBCT: 29.3, [27.5, 30.7] min; p < 0.0001).ConclusionsThe choice of imaging technology for navigated pedicle screw placement has significant impact on standard spine procedures even in a high-volume spine center with daily routine in such devices. Particularly with regard to the duration of surgeries, the shorter time needed for preparation and de-positioning in the ORCT group made the main difference, while the accuracy was even higher for the ORCT.

Clinical efficiency of operating room-based sliding gantry CT compared to mobile cone-beam CT-based navigated pedicle screw placement – a study on 853 patients and 6733 screws

Clinical efficiency of operating room-based sliding gantry CT compared to mobile cone-beam CT-based navigated pedicle screw placement – a study on 853 patients and 6733 screws

Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement. An observational cohort study on 853 patients and 6733 screws

Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement. An observational cohort study on 853 patients and 6733 screws

Radiation doses of sliding gantry CT-based as compared to mobile cone-beam CT-based navigated pedicle screw placement in a homogenous cohort

Radiation doses of sliding gantry CT-based as compared to mobile cone-beam CT-based navigated pedicle screw placement in a homogenous cohort

Radiation doses of sliding gantry ct-based as compared to mobile cone-beam CT-based navigated pedicle screw placement in a homogenous cohort

Radiation doses of sliding gantry ct-based as compared to mobile cone-beam CT-based navigated pedicle screw placement in a homogenous cohort

The Role of Intraoperative Navigation in Orthopaedic Surgery.

An orthopaedic surgeon's knowledge of anatomical landmarks is crucial, but other modalities supplement this by providing guidance and feedback to a surgeon. Advances in imaging have enabled three-dimensional visualization of the surgical field and patient anatomy, whereas advances in computer technology have allowed for real-time tracking of instruments and implants. Together, these innovations have given rise to intraoperative navigation systems. The authors review these advances in intraoperative navigation across orthopaedic subspecialties, focusing on the most recent evidence on patient outcomes and complications, the associated learning curve, and the effects on operative time, radiation exposure, and cost. In spine surgery, navigated pedicle screw placement may increase accuracy and safety, especially valuable when treating complex deformities. Improved accuracy of pelvic and peri-articular tumor resection and percutaneous fixation of acetabular and femoral neck fractures has also been achieved using navigation. Early applications in arthroscopy have included surface-based registration for tunnel positioning for anterior cruciate ligament reconstruction and osteochondroplasty for femoro-acetabular impingement. Navigated arthroplasty techniques have addressed knee gap balancing and mechanical axis restoration as well as acetabular cup and glenoid baseplate positioning. Among these orthopaedic subspecialties, significant variation is found in the clinical relevance and dedication to research of navigation techniques.

Minimally invasive guidewireless, navigated pedicle screw placement: a technical report and case series.

OBJECTIVE Percutaneous pedicle screw insertion (PPSI) is a mainstay of minimally invasive spinal surgery. Traditionally, PPSI is a fluoroscopy-guided, multistep process involving traversing the pedicle with a Jamshidi needle, placement of a Kirschner wire (K-wire), placement of a soft-tissue dilator, pedicle tract tapping, and screw insertion over the K-wire. This study evaluates the accuracy and safety of PPSI with a simplified 2-step process using a navigated awl-tap followed by navigated screw insertion without use of a K-wire or fluoroscopy. METHODS Patients undergoing PPSI utilizing the K-wire-less technique were identified. Data were extracted from the electronic medical record. Complications associated with screw placement were recorded. Postoperative radiographs as well as CT were evaluated for accuracy of pedicle screw placement. RESULTS Thirty-six patients (18 male and 18 female) were included. The patients' mean age was 60.4 years (range 23.8-78.4 years), and their mean body mass index was 28.5 kg/m2 (range 20.8-40.1 kg/m2). A total of 238 pedicle screws were placed. A mean of 6.6 pedicle screws (range 4-14) were placed over a mean of 2.61 levels (range 1-7). No pedicle breaches were identified on review of postoperative radiographs. In a subgroup analysis of the 25 cases (69%) in which CT scans were performed, 173 screws were assessed; 170 (98.3%) were found to be completely within the pedicle, and 3 (1.7%) demonstrated medial breaches of less than 2 mm (Grade B). There were no complications related to PPSI in this cohort. CONCLUSIONS This streamlined 2-step K-wire-less, navigated PPSI appears safe and accurate and avoids the need for radiation exposure to surgeon and staff.

Pulmonary cement embolism after navigated pedicle screw placement

Sun, Derrick MDa; Burger, Evalina L. MDb; Weyant, Michael J. MDc; Lindley, Emily M. PhDb; Patel, Vikas V. MDb Author Information

Navigated pedicle screw placement using computed tomographic data in dorsolumbar fractures.

Background:Computed tomographic (CT) based navigation is a technique to improve the accuracy of pedicle screw placement. It is believed to enhance accuracy of pedicle screw placement, potentially avoiding complications arising due to pedicle wall breach. This study aims to assess the results of dorsolumbar fractures operated by this technique.Materials and Methods:Thirty consecutive skeletally mature patients of fractures of dorsolumbar spine (T9–L5) were subjected to an optoelectronic navigation system. All patients were thoroughly examined for neurological deficit. The criterion for instability were either a tricolumnar injury or presence of neurological deficit or both. Patients with multilevel fractures and distorted spine were excluded from study. Time taken for insertion of each pedicle screw was recorded and placement assessed with a postoperative CT scan using Laine's grading system.Results:Only one screw out of a total of 118 screws was misplaced with a Laine's Grade 5 placement, showing a misplacement rate of 0.847%. Average time for matching was 7.8 min (range 5-12 min). Average time taken for insertion of a single screw was 4.19 min (range 2-8 min) and total time for all screws after exposure was 34.23 min (range 24-45 min) for a four screw construct. No neurovascular complications were seen in any of the patients postoperatively and in subsequent followup of 1-year duration.Conclusion:CT-based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9-L5), however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries. Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.