Accuracy of ‘O arm’ guided pedicle screw placement in osteoporotic spine with the ‘precious pedicle’

Introduction: Osteoporosis is a global burden with the prevelance ranging from 15 to 20% in women and 4–7% in men across the globe. This is the age group which most commonly presents in spine clinic with pathologies requiring pedicle screw fixation. Pedicle screw fixation in osteoporotic spine is a challenge pertaining to the poor bone quality leading to various complication like screw backout, loosening and pedicle breach. With the advent of O arm and navigation, it is now possible to place pedicle screw with reported accuracy of 96%. Here, in this one of a kind study, we study the accuracy of O arm guided pedicle screw insertion in osteoporotic spine. Materials and method: This is a retrospective study of patients operated between July 2020 to December 2020 for pedicle screw fixation at a tertiary care center by a single senior spine surgeon using O arm (O2) Navigation. All patients, over the age of 55 years having osteoporosis; defined by Singh’s index; who were operated for lumbar pedicle screw fixation were included in the study. All patients under the age of 55 or having Singh’s index of more than 3 were excluded. Results: All the patients operated at a tertiary care center by a single senior spine surgeon was considered in our study. Of 67 patients operated between July 2020 to December 2020 using O arm navigation, 32 patients fit into our criteria. Total 172 pedicle screws were inserted in osteoporotic spine. One of the patients had one pedicle breach in our group intra operatively which needed reinsertion of screw. Conclusion: O arm guided pedicle screw placement is a novel technique which seems to be the most accurate technique till date. With an accuracy of 99.5% in osteoporotic spine, this should be the method of choice when using pedicle screws, whenever available.