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Updated: Jul 14, 2026

Pedicle Screw Placement Using an Augmented Reality Head-Mounted Display in a Porcine Model
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Thoracic pedicle screw placement: analysis using anatomical landmarks without image guidance.

Michael J Elliott1, Joseph B Slakey

  • 1Naval Medical Center Portsmouth, Virginia, USA. melliott@childrenscentalcal.org

Journal of Pediatric Orthopedics
|June 23, 2007
PubMed
Summary

Freehand thoracic pedicle screw placement without image guidance demonstrated minimal pedicle wall disruption in a cadaver study. This technique is safe and effective for spinal deformity correction.

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Area of Science:

  • Orthopedic surgery
  • Spinal instrumentation
  • Surgical anatomy

Background:

  • Thoracic pedicle screws are increasingly used for spinal deformity correction.
  • Concerns exist regarding neurological/vascular risks and surgeon experience.
  • This study evaluated a freehand technique's safety without image guidance.

Purpose of the Study:

  • To assess the safety and efficacy of freehand pedicle screw placement in the thoracic spine.
  • To determine the rate of pedicle wall violations using this technique.
  • To compare results with image-guided methods.

Main Methods:

  • Prospective laboratory study using six fresh cadaveric specimens (T4-T11).
  • Ninety-six pedicle screws placed freehand along the anatomical axis.

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An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model
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An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

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Last Updated: Jul 14, 2026

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Published on: May 24, 2024

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  • Cadaveric dissection to evaluate pedicle wall violations and neural structure proximity.

    • Main Results:

    • 97% of screws had <1 mm wall violation; 87.5% were fully contained.
    • Only 4.16% violated the medial cortex; no superior, inferior, or anterior violations.
    • Nerve roots contacted the inferior pedicle wall; average superior distance was 3.85-5.04 mm.

    Conclusions:

    • Freehand thoracic pedicle screw placement yields low pedicle wall disruption.
    • The technique offers a reproducible starting point.
    • Results are comparable or superior to image-guided methods in cadaveric studies.