Accuracy of Navigated High-Speed Drill-Assisted Cervical and Upper Thoracic Pedicle Screw Placement—A Single Center Experience with 1112 Pedicle Screws

Background/Objectives: While biomechanically superior, cervical pedicle screw placement is technically challenging, and therefore typically performed only in centers with the aid of navigation. The purpose of this study was to analyze the accuracy and safety of navigated cervical pedicle screw (CPS) placement using intraoperative imaging with a workflow using a navigated high-speed drill in a large single-center cohort. Methods: We conducted a retrospective analysis of 205 patients undergoing posterior cervical or cervicothoracic instrumentation between January 2018 and June 2024. Accuracy was assessed using the Gertzbein–Robbins classification, with grades 0 and 1 considered satisfactory. Surgical workflow, intraoperative imaging, and complications were analyzed. Results: A total of 1112 pedicle screws, including 888 cervical and 224 upper thoracic screws, were evaluated. 801 were grade 0 (72.0%), 250 grade 1 (22.5%), 56 grade 2 (5.0%), and 5 grade 3 (0.4%). Cervical screws achieved satisfactory placement grades 0 and 1 in 93.1%, and upper thoracic screws in 100% (92.0% grade 0, 8.0% grade 1). Grade 3 breaches occurred in C2, C3, C5, C6, and C7, with one case each. There were no cases of implant-related neurovascular injuries. Conclusions: This study demonstrates high screw accuracy with a low observed complication rate. No revision surgeries were required due to screw malposition, but 7 cases of screw loosening occurred. However, the retrospective design and reliance on intraoperative imaging limit the generalizability of the findings.