Study Comparing the PathKeeper System for Pedicle Screw Positioning in Spine Surgery With Traditional Care

The goal of this is to evaluate performance of the Pathkeeper Surgical System. The main question\[s\]it aims to answer are: 1) evaluate pedicle screw position Participants will in compare Experimental arm: PathKeeper System (PKS) with control arm

Trial design * Allocation: Randomized * Interventional Model: Parallel Assignment (double armed) * Interventional Model Description: Dual center, prospective, randomized cohort study. * Masking: None (Open Label) * Primary Purpose: Treatment * Enrolment: 32 (thirty-two) patients - 16 (sixteen) patients experimental and 16 control arms (100 screws each arm, estimated 20% of patients drop out). Study arms 1. Experimental arm: PathKeeper System (PKS) One to ten-level posterior, open, instrumented spine surgery using unilateral or bilateral pedicle screw instrumentation under PKS intraoperative navigation guidance. Interventions: Medical Devise - PKS. The PKS spine navigation system is for spatial positioning and orientation of surgical instruments during pedicle screw implantation in patients undergoing posterior fixation in single or multiple levels. 2. Control arm: free-hand technique guided by intra-operative 2D Fluoroscopy One to ten-level posterior, open, instrumented spine surgery using unilateral or bilateral pedicle screw instrumentation under free-hand technique guided by intra-operative 2D fluoroscopy. Interventions: Pedicle screws will be placed using the free-hand technique with 2D fluoroscopy as the intraoperative imaging modality. Primary endpoints: Evaluate and classify the pedicle screw positions as per the Gertzbein-Robbins classification scale based on a low-dose post-operative CT scan, in each study arm and comparatively. Number of misaligned screws as per the Gertzbein-Robbins classification scale (Gertzbein and Robbins, 1990) class E screws class D screws class C screws class B screws class A screws Secondary endpoints: 1. Evaluate radiation exposure dose and time in the operating room during the procedure in each study arm and comparatively. 2. Evaluate time-per-screw for the experimental device arm (PKS) arm. 3. Length of stay - (non-critical) 4. Estimated blood loss (EBL) - (non-critical) 5. Number of reported complications (neurological deficits, dural tears, deep wound infections, etc.) while hospitalized