Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion: Clinical article

Yasuo Ito, Yoshihisa Sugimoto, Masao Tomioka, Yasuhiro Hasegawa, Kie Nakago, Yukihisa Yagata

Research output: Contribution to journalArticlepeer-review

106 Citations (Scopus)


Object. Cervical pedicle screw (PS) misplacement leads to injury of the spinal cord, nerve root, and vertebral artery. Recently, several investigators reported on the usefulness of a spinal navigation system that improves the accuracy of PS insertion. In this study, the authors assessed the accuracy of cervical pedicle, lateral mass, and odontoid screw insertions placed using a 3D fluoroscopy navigation system, the Iso-C3D unit. Methods. In this prospective analysis of the authors' initial 50 cases of 3D fluoroscopy-assisted cervical screw insertion, the authors inserted 176 PSs, 58 lateral mass screws, and 5 odontoid screws into the C1-7 vertebrae. They placed screws using intraoperative acquisition of data by the isocentric C-arm fluoroscope and a computer navigation system. They obtained postoperative fine-cut CT scans in all patients and assessed the accuracy of screw insertion. Results. A PS (≥ 3.5 mm) could be inserted into 24 (63%) of 38 pedicles at the level of C-3, 18 (53%) of 34 pedicles at C-4, 30 (65%) of 46 at C-5, 33 (80%) of 41 at C-6, and 43 (100%) of 43 at C-7. Of 176 PSs inserted into vertebrae between C-2 and C-7, 171 screws (97.2%) were classified as Grade 1 (no pedicle perforation), and 5 screws (2.8%) were classified as Grade 2 (screw perforation of the cortex by up to 2 mm). Clinically significant screw deviation in the present study was considered Grade 3 (screw perforation of the cortex by > 2 mm), and this occurred in 0% of the placements. Conclusions. In this study, the authors were able to correctly insert cervical PSs using the 3D fluoroscopy and navigation system.

Original languageEnglish
Pages (from-to)450-453
Number of pages4
JournalJournal of Neurosurgery: Spine
Issue number5
Publication statusPublished - Nov 1 2008


  • IsoC-3D
  • Neuronavigation
  • Pedicle screw
  • Three-dimensional fluoroscopy

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology


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