Accuracy of Percutaneous Pedicle Screw Placement: Does Training Level Matter?

Area of Science:

• Spinal surgery techniques
• Orthopedic surgery outcomes
• Surgical anatomy education

Background:

• Percutaneous pedicle screw placement accuracy varies in literature.
• The impact of surgeon experience on screw placement accuracy is not well-documented.

Purpose of the Study:

• To evaluate the accuracy of percutaneous pedicle screw placement in a human cadaver model.
• To compare screw placement accuracy across different surgeon experience levels using fluoroscopic guidance.

Main Methods:

• An in vitro study involving 10 human cadavers, instrumented from L1 to S1 bilaterally (120 screws total).
• Four surgeons with varying training levels (PGY-2, PGY-4, fellow, attending) performed screw placement.
• Specimens were dissected to identify and analyze facet and pedicle wall violations.

Main Results:

• Overall, 35 violations occurred among 120 screws (21.7% superior articular facet, 4.2% intra-articular facet joint, 3.3% pedicle breaches).
• No significant difference in violation rates was found among trainees (P=0.8863).
• Attending surgeons demonstrated a significantly lower likelihood of violations compared to trainees (P=0.0175).

Conclusions:

• Surgeons at different training levels can achieve safe and accurate percutaneous lumbar pedicle screw placement.
• The study indicates a low incidence of facet and pedicle wall violations across experience levels.
• Findings support the safety and efficacy of fluoroscopic-guided percutaneous screw placement in a cadaveric setting.