Researchers conducted a retrospective analysis of surgical data from cadaveric cervical spines. For a study, the researchers sought to compare neuronavigation to laminotomy with direct vision (DV) of the pedicle to place subaxial pedicle screws. About 6 cadaveric spines (occiput to T2) were produced using fresh-frozen cadaveric spines. The DV or neuronavigation techniques were used to implant pedicle screws from C3 to C7 on each side (alternating sides between specimens). Pedicles with sizes less than 4 mm were ruled out. A hemilaminectomy was conducted for DV of pedicle boundaries and to determine the DV procedure’s optimal screw medialization and trajectory. CT-based navigation with a reference frame installed on the C2 spinous process was used to implant neuronavigation screws. Postoperative CT assessed the screw location, and the Neo classification was used to classify the breaches. About 50 pedicle screws were inserted at 25 levels in six cadaveric spines, employing neuronavigation or DV to put 25 screws each. There was no discernible difference in accuracy between the 2 strategies. However, 3 breaches (12%) occurred in the DV group, while 9 violations (36%) occurred in the neuronavigation group (P=0.10). All levels were equally affected by the breaches. With DV, there were no high-grade breaches, and with neuronavigation (P>0.99), there was just 1 (4.0%). Levels with no break had wider average pedicle cortical and medullary bone widths (P=0.009 and P=0.02, respectively). Both neuronavigation and DV can be used to insert subaxial cervical pedicle screws in cadavers with high accuracy.
