Professor UCSF UC San Francisco San Francisco, CA, US
Introduction: Spinal stabilization and fusion procedures require precise pedicle screw placement. Navigation systems aim to enhance accuracy and safety, yet the impact on surgical workflow and efficiency remains a concern. This study compares two navigation systems by assessing the time taken for pedicle screw placement in a controlled cadaveric environment.
Methods: An experienced spine surgeon placed eighteen (T10 to S1) pedicle screws in a cadaver using two navigation systems. The right side screw placements utilized the lightfield navigation system while the left side placement utilized the stereotactic navigation system. After anatomy exposure, time was recorded for each procedural step from navigation registration to implant placement. Intraoperative imaging times and radiation exposure were also recorded when required for navigated use. Data were analyzed to compare the total time taken for each system.
Results: The CBCT navigation system required 55.1 minutes for total procedure completion while the lightfield navigation required 26.9 minutes. The difference was primarily attributed to intraoperative imaging. The three CBCT scans required 26.4 minutes while the lightfield navigation system requires no intraoperative imaging time. Furthermore, intraoperative imaging exposes the patient to radiation. The difference in CTDI was reported as 128.73 mGy when registering with the CBCT navigation system.
Conclusion : This study demonstrates that lightfield navigation is more efficient than CBCT navigation for pedicle screw placement in a cadaveric model. The lightfield navigation workflow may reduce overall surgical time, minimize anesthesia duration and intraoperative radiation exposure. While a cadaveric experiment, the results demonstrate significant clinical implications for simplifying surgical workflow and enhancing patient safety.