Reliable pedicle screw placement is central to achieving stable fixation in thoracolumbar spine fracture surgery. Conventional C-arm fluoroscopy provides two-dimensional guidance and exposes operating room personnel to radiation, whereas O-arm–based navigation offers three-dimensional intraoperative imaging with potentially improved accuracy. This study compares functional outcomes, pedicle screw accuracy, fluoroscopy use for operating room personnel, and complications between C-arm fluoroscopy–guided and O-arm navigation–guided posterior fixation in thoracic and lumbar spine fractures.

This prospective comparative study included adult patients with traumatic thoracic or lumbar spine fractures undergoing posterior pedicle screw fixation. Patients were allocated to either C-arm fluoroscopy–guided surgery or O-arm navigation–guided surgery based on imaging availability. Functional outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Pedicle screw accuracy was evaluated on postoperative computed tomography using the Gertzbein–Robbins classification. Secondary outcomes included operative time, blood loss, fluoroscopy time as a surrogate for radiation exposure to operating room personnel, and postoperative complications. Statistical analysis was performed with a significance level of p < 0.05.

A total of 338 patients (169 per group) were analyzed. Baseline demographic and injury characteristics were comparable. Both groups demonstrated significant postoperative improvement in VAS and ODI scores, with no significant intergroup difference at final follow-up. The O-arm group showed a significantly higher proportion of Grade A pedicle screws (p < 0.05). Fluoroscopy time was significantly lower in the O-arm group, whereas operative time was longer. Although complication and revision rates were higher in the C-arm group, the difference was not statistically significant (p > 0.05).

O-arm navigation significantly improves pedicle screw accuracy and reduces fluoroscopy use for operating room personnel without compromising functional outcomes. Despite longer operative time, O-arm navigation represents a valuable adjunct in the management of thoracolumbar spine fractures, particularly in complex trauma cases.

Written informed consent was obtained from the patient for publication of clinical details and images.

V.G. contributed to concept, design, acquisition of clinical data and literature review. P.G. contributed to radiological interpretation. V.G. drafter the manuscript. Both the authors contributed to critical revision of the manuscript and approve the final version of the manuscript.

Article published online:
07 May 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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