Ho-ho-ho! Gather ’round, my merry friends, for I have a tale from the land of spine surgery, where skilled elves—ahem, I mean surgeons—work tirelessly to fix the wobbly backbones of those in need. In this yuletide story, we’re comparing two magical methods of guiding pedicle screws into place, much like how I guide my sleigh through the wintry night sky.

In the bustling workshop from 2018 to 2020, a grand total of 222 patients had their spines decked with 1288 shiny pedicle screws. These screws were nestled snugly in the thoracic and lumbosacral regions, all through a posterior approach, much like how I slide down chimneys posterior-first!

Now, listen closely, for here’s where the magic happens. In one group, 107 patients (48.2% of our holiday crew), composed of 48 dashing men and 59 graceful women, received their screws freehand under the twinkling light of conventional fluoroscopy, which we’ll call the C-arm group. Meanwhile, 115 patients (51.8%), with 53 strapping men and 62 lovely women, had their screws guided by the wondrous O-arm, with the StealthStation neuronavigation system (straight from the North Pole’s tech department) leading the way—let’s call this the O-arm group.

The elves—er, surgeons—recorded their work and later, by the glow of the fireplace, analyzed it with the help of CT imaging, using the Gertzbein-Robbins classification as their list (and they checked it twice!).

In the C-arm group, each patient received an average of 6.21 ± 2.1 screws, and in the O-arm group, a slightly less average of 5.59 ± 1.6 screws. The C-arm group took about 3:57 ± 1:07 hours for the procedure, while the O-arm group took a bit longer, around 4:21 ± 1:41 hours. But here’s the jolly good news: a correct screw placement was found in 92.78% of the C-arm group and an even more impressive 98.13% in the O-arm group!

Now, not all screws nestled as snugly as children in their beds. There were a few breaches here and there—medial, lateral, and even anterior vertebral body breaches. But fear not, for the O-arm group showed fewer of these mischievous misplacements. And when it came to reoperations for these naughty screws, only five patients in the C-arm group and two patients in the O-arm group had to return to the workshop.

In the end, my dear friends, the O-arm system, with its navigation magic, proved to be the more accurate choice for pedicle screw placement, ensuring a merry and bright postoperative season for all. And with that, I must return to my sleigh, for there are more tales to tell and spines to fix. Merry fixing to all, and to all a good night! 🎅🎄