Related Experiment Video
Updated: Feb 17, 2026
A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement
Published on: May 11, 2020
Power-drill fluoroscopy-controlled technique as an alternative to navigation-assisted pedicle screw placement: A
Felix Corr1, Faizan Kareem2, Linda Bättig1
1Department of Neurosurgery & Interdisciplinary Spine Center, HOCH Health Ostschweiz, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
Introduction:
Power-drill fluoroscopy-controlled freehand (PFH) pedicle screw placement is a drill-based refinement of the freehand technique that combines fluoroscopic control with tactile feedback. Its performance in degenerative spine surgery remains underexplored. This study compared the accuracy and procedural characteristics of PFH and navigation-assisted (NA) screw placement in thoracolumbar posterior fusion.
Research Question:
To investigate whether PFH pedicle screw placement achieves comparable accuracy to NA techniques in degenerative thoracolumbar fusion surgery.
Material And Methods:
Adults undergoing elective thoracolumbar fusion with PFH or NA pedicle screw placement were retrospectively analyzed. Propensity score matching balanced demographic and clinical variables between groups. Screw accuracy was graded by the Gertzbein-Robbins Scale (GRS). Secondary outcomes included radiation exposure and perioperative variables. A generalized linear mixed model accounted for multiple screws per patient.
Results:
After matching, 35 patients per group were analyzed (PFH, 224 screws; NA, 154 screws). Satisfactory screw placement was achieved in 97.8% of PFH and 93.5% of NA screws (p = 0.02). Revision rates within 12 months were similar (5.7% vs 17.1%; p = 0.26). Radiation exposure was lower with PFH (8378 ± 5302 vs 23,793 ± 13,162 mGy cm2; p < 0.001), despite longer constructs and more frequent cement utilization. Osteoporosis independently reduced accuracy (OR 0.43; 95% CI, 0.20-0.92; p = 0.02).
Discussion And Conclusion:
In this propensity-matched analysis, PFH demonstrated accuracy comparable to NA (absolute difference 4.3 percentage points) with significantly lower patient radiation exposure. Further investigations are needed to justify the PFH method as a potential alternative in selected degenerative cases where radiation reduction is prioritized or navigation is unavailable.
