With the increasing trend toward minimally invasive and precision surgery, the importance of intraoperative imaging has become more pronounced. In recent years, 3D C-arm intraoperative imaging for spine and orthopedic surgery has been widely adopted in modern operating rooms. Compared with traditional fluoroscopy systems, the advantages of 3D C-arm over conventional C-arm in minimally invasive surgery are becoming increasingly evident.
The 3D C-arm provides high-precision, quantifiable imaging support through multi-angle scanning and three-dimensional reconstruction. This article analyzes the clinical advantages of the 3D C-arm from four core perspectives, compares it with traditional 2D C-arms, and illustrates its clinical value through representative cases.
1️⃣ Three-dimensional Imaging: Enhancing Intraoperative Accuracy
Technical Analysis
The 3D C-arm acquires multi-angle projection data through a 360° rotational scan, generating axial, coronal, and sagittal images and reconstructing high-resolution 3D images (up to 150 μm resolution).
Scanning time is approximately 10–20 seconds, covering the entire surgical area such as the full spine or large pelvic regions.
Traditional 2D C-arms provide only single-plane images, requiring repeated fluoroscopy to assess instrument placement, which limits spatial awareness and increases the risk of misinterpretation.
Compared with conventional imaging, 3D C-arm intraoperative imaging for spine and orthopedic surgery allows surgeons to evaluate anatomical structures and implant positioning more accurately.
Clinical Cases
Lumbar Spinal Fixation Surgery:
A 56-year-old patient with L4–L5 spondylolisthesis underwent surgery. Intraoperative scanning with the PLX C7600 3D C-arm identified a misplaced screw, which was adjusted during the procedure for precise placement. Postoperative imaging confirmed correct positioning, and neural function remained intact.
Pelvic Fracture Surgery:
A patient with multiple pelvic fractures underwent intraoperative 3D imaging that guided accurate reduction and screw placement. Postoperative imaging showed a fracture reduction rate of 96% and excellent functional recovery.
Joint Replacement Surgery:
3D C-arm imaging enabled accurate assessment of prosthesis orientation and positioning, reducing the risk of postoperative malalignment.
Quantitative Comparison
| Metric | 3D C-arm | 2D C-arm |
|---|---|---|
| Scan coverage | Full spine / pelvis | Single plane, requires repositioning |
| Spatial awareness | 360° three-dimensional | Flat, prone to misjudgment |
| Intraoperative adjustment rate | 12–15% detectable and correctable | Dependent on postoperative review or repeated fluoroscopy |
Advantages Summary
- Improves intraoperative accuracy
- Reduces the risk of secondary surgery
- Provides real-time and quantifiable surgical decision support
2️⃣ Surgical Workflow Optimization: Shorter Operation Time and Reduced Radiation
Technical Analysis
The 3D C-arm can cover the target surgical area in a single scan with rapid image reconstruction for immediate intraoperative display.
Smart exposure control technology can reduce radiation exposure by approximately 30–50%.
In contrast, traditional 2D C-arms require multiple fluoroscopic checks and frequent angle adjustments, which increases operation time and cumulative radiation exposure.
These differences clearly demonstrate the advantages of 3D C-arm over conventional C-arm in minimally invasive surgery, particularly in procedures that demand high imaging accuracy.
Clinical Cases
Hepatic Artery Embolization:
During interventional treatment for hepatocellular carcinoma, a PLX C9100 mobile interventional C-arm provided clear visualization of vascular structures and guidewire positioning. The procedure time was reduced from about 30 minutes to 18 minutes, while radiation exposure decreased by approximately 40%.
Minimally Invasive Spine Surgery:
A single 3D scan covered the entire spinal region, replacing multiple 2D fluoroscopy sessions and saving 15–20 minutes of operative time.
Joint Replacement Surgery:
The use of 3D imaging reduced intraoperative fluoroscopy sessions, thereby improving surgical workflow efficiency.
Quantitative Comparison
| Metric | 3D C-arm | 2D C-arm |
|---|---|---|
| Average operation time | Reduced by 15–20% | Baseline |
| Fluoroscopy frequency | 1–2 times | 5–8 times |
| Intraoperative radiation | Reduced by 30–50% | Higher cumulative dose |
Advantages Summary
- Increases surgical efficiency
- Reduces intraoperative radiation exposure
- Supports faster intraoperative decision-making
3️⃣ Enhancing Surgical Safety: Reducing Complications
Technical Analysis
The 3D C-arm provides clear visualization of bones, screws, and surrounding neurovascular structures, with image resolution up to 0.15 mm.
It can also be integrated with intraoperative navigation systems to support surgical path planning and error correction.
Traditional 2D C-arms provide only planar imaging, which may lead to incomplete visualization of important anatomical structures during minimally invasive procedures.
Clinical Cases
Complex Pelvic Fracture Fixation:
Among 50 patients treated with intraoperative 3D imaging, screws requiring adjustment were detected in 12% of cases before surgery completion. No postoperative neurovascular injuries occurred. In comparison, similar procedures performed with conventional 2D C-arms reported a neurovascular injury rate of approximately 2–3%.
Minimally Invasive Spine Surgery:
In a clinical series of 30 patients, 3D-guided screw placement reduced intraoperative blood loss by about 20% and resulted in zero nerve injuries.
Shoulder Arthroplasty:
Intraoperative 3D imaging ensured accurate prosthesis alignment and prevented postoperative rotational deformities.
Advantages Summary
- Reduces the risk of intraoperative complications
- Improves surgical controllability
- Provides greater safety for minimally invasive procedures
4️⃣ Supporting Intraoperative Navigation and Robotic Surgery: Advancing the Digital Operating Room
Technical Analysis
3D C-arm systems generate volumetric imaging data that can be transmitted in real time to navigation platforms or robotic surgical systems.
This capability supports surgical path planning, real-time positioning, and intraoperative error correction.
In contrast, 2D C-arm systems provide only planar references, limiting the precision required for advanced navigation or robotic-assisted procedures.
Clinical Cases
Minimally Invasive Spine Surgery:
Combining 3D C-arm imaging with navigation systems increased pedicle screw placement accuracy from 92% (using conventional fluoroscopy) to approximately 98%.
Complex Interventional Procedures:
Robot-assisted procedures using 3D C-arm guidance enabled precise guidewire positioning and reduced average operation time by around 15%.
Knee Arthroplasty:
Intraoperative 3D imaging combined with navigation improved prosthesis alignment and postoperative functional recovery compared with procedures guided by 2D C-arm imaging.
Advantages Summary
- Improves surgical precision and success rate
- Supports complex minimally invasive procedures
- Promotes digitalization and intelligent operating room systems
Conclusion
Compared with traditional 2D C-arm systems, 3D C-arms provide significant advantages in intraoperative imaging, surgical efficiency, safety, and digital surgical support.
These benefits clearly demonstrate the advantages of 3D C-arm over conventional C-arm in minimally invasive surgery, particularly in complex spine and orthopedic procedures.
Today, 3D C-arm intraoperative imaging for spine and orthopedic surgery plays a critical role in improving surgical accuracy, reducing complications, and supporting the development of digital and precision medicine.
Representative systems such as the PLX C7600 3D C-arm and PLX C9100 mobile interventional C-arm have already been widely applied in orthopedic, spinal, and interventional procedures, confirming their value in enhancing surgical precision, safety, and efficiency.
