Are pedicle screw perforation rates influenced by distance from the reference frame in multilevel registration using a computed tomography-based navigation system in the setting of scoliosis?

In multilevel registration of three consecutive vertebrae, the accuracy of screw insertion into vertebrae at which the reference frame was not set was not significantly inferior to that in vertebrae at which the reference frame was set with regard to major perforation rate. Including minor perforations, however, a distance of three vertebrae or more above or below the reference frame vertebra produced significantly more frequent perforations.