Neurology India, Vol. 59, No. 5, September-October, 2011, pp. 795-796
Comment on: Use of O-arm for spinal surgery in academic institution in India: Experience from JPN apex trauma centre
Department of Orthopaedics, Division of Spine and Musculoskeletal Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
I read with interest the article titled "Use of O-arm for spinal surgery in academic institution in India: Experience from JPN apex trauma centre" by Ailawadhi et al.,  in the recent issue of Neurology India. Distorted anatomy following spine injury does not resemble deformed pedicles seen in a deformity such as scoliosis. Thus, in the present study all the screws had been inserted into essentially normal pedicles away from the fractured segment and 100% success using O-arm in these patients is hardly surprising. Moreover, the study population is a non-homogenous cohort and included from odontoid to lumbar levels. Inclusion of O-arm images of the screw placements would have added more originality to the presentation. Kim et al., in their review article reported freehand technique of pedicle screw insertion to more than 8000 thoracic pedicles without any neurological, vascular or visceral complications.  Parker et al., recently reported 6816 freehand pedicle screw placements and concluded that based on external anatomy alone pedicle screw insertion can be performed with acceptable safety and accuracy.  O-arm and navigation tools are expensive and not widely available. Therefore, it is important to impart intense training of freehand technique to residents under strict supervision in academic institutions. I would like to congratulate the authors for their effort in displaying their work and hope to see more of their work in future.
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