Imaging-guided surgery provides intraoperative real-time navigation for spinal surgery to prevent neurovascular injury. However, the initial experience of O-arm three-dimensional (3D) navigation is less clarified. The study aims to evaluate the accuracy of O-arm 3D navigation-assisted spinal implantation. Implantation of total 742 transpedicle/lateral mass screws in 128 patients were performed through O-arm 3D computed tomography (CT) imaging navigation. Etiological distribution, level wise distribution and screws accuracy were assessed. O-arm 3D navigation included 706 pedicle screws (both lumbar and cervical), 22 lateral mass screws and 14 translaminar screws. The accuracy rate of screw implantation was 97.1% (721/742) without breach (Grade 0), whereas 1.07% (8/742) implants had breach between 2 and 4 mm (Grade 2). In the cervical spine, 108 screws including pedicle, lateral mass and translaminar screws were placed in 25 patients; out of them 2.77% (3/108) exhibited Grade 2 breach. In dorsal spine 164 pedicle screws were placed in 32 patients, out of them 1.2% (2/164) screws exhibited Grade 2 breach. In the lumbosacral spine, 470 pedicle screws were placed in 66 patients. Out of them, 0.6% (3/470) exhibited Grade 2 breach. None of the patient had Grade 3 breach. Hence, we conclude that O-arm 3D navigation achieves a relatively high accuracy of pedicle and lateral mass screws implantationthe tools used for each category of these techniques are also compiled and presented in this literature review.

O-arm, Navigation guided spine surgery, Spinal instrumentation, Pedicle screw insertion, accuracy