A Retrospective Analysis of Guidewireless Versus Guidewire-Assisted Navigated Percutaneous Pedicle Screw Placement...

Pedicle screw fixation is a cornerstone of spinal fusion surgery due to its superior biomechanical stability. While conventional Kirschner wire (K-wire)-guided techniques are widely used, they involve multiple steps and are associated with specific complications. The introduction of the tip-tap awl allows for a guidewireless, single-pass insertion technique, potentially improving surgical efficiency while maintaining accuracy.

A retrospective analysis was conducted on patients who underwent minimally invasive spine surgery (MISS) with navigated pedicle screw (Medtronic, Littleton, USA) insertion at a single tertiary center. Two navigated techniques were compared: the conventional K-wire-guided method and a guidewireless method using a navigated tip-tap awl (Medtronic, Minneapolis, USA). Data on intraoperative workflow, screw insertion time, complications, and breach rates were collected and analyzed.

A total of 488 screws were evaluated in 122 patients. Screws were placed using either the guidewire method (56 patients) or the guidewireless method (66 patients). Both groups showed high accuracy, with minimal breach rates and no clinically significant postoperative complications. The guidewireless method required fewer procedural steps and demonstrated an average reduction in screw insertion time of 1.30 minutes per screw.

The tip-tap awl simplified screw insertion by combining entry and tapping into a single navigated step. This streamlining of the procedure contributed to a more efficient surgical workflow. Despite fewer steps, complication and breach rates remained comparable to the traditional technique, indicating that safety and accuracy were not compromised.

In this retrospective cohort, the guidewireless technique was associated with reduced screw insertion times and a favorable safety profile, suggesting it may serve as an efficient alternative to traditional methods.