Power-assisted pedicle screws placement: Is it as safe and as effective as manual technique? Narrative review of the literature and our technique

Abstract

Pedicle screws are the gold standard in spine surgery, allowing a solid tricolumnar fixation which is unmatched by hooks and wires. The freehand technique is the most widely adopted for pedicle screws placing. While freehand technique has been classically performed with manual tools, there has been a recent trend toward the use of power tools. The aim of this review is to summarize and expose potential risks and advantages of power pedicle screws placing. The literature showed that the use of power tools offers an acceptable safety profile, comparable to manual technique. With an adequate training, the power technique may speed up the screw placing, reduce the fluoroscopy time and the physical stress to the spine surgeon. Regarding differences in pull-out strength between power and manual techniques, the literature is still uncertain and inconsistent, both in clinical and preclinical studies. The choice between the use of power and manual freehand pedicle screws placing is still based on the surgeon’s own preference.

Multilevel non-contiguous thoracic pedicle subtraction osteotomy for fixed rounded hyperkyphotic deformity of the thoraco-lumbar junction with anterior bony fusion: technical note

“…Finally, after tapping, polyaxial screws of an appropriate length and diameter were inserted according to the planned model. When customized guides were not needed (in one case), a freehand technique was used [9].…”

Return to sport after posterior spinal fusion for adolescent idiopathic scoliosis: what variables actually have an influence? A retrospective study

“…According to the presented results, high-density posterior spinal fusion (PSF) for AIS confirmed to be a safe (no major complications) and effective technique (70.0 ± 12.5% correction of the main curve), that allowed patients to return safely to any kind of physical activity within a few months from surgery [ 13 ]. Moreover, the vast majority of included patients (67.8%) reached at least the same level as preoperatively (primary outcome of the study), more than half of them (52.6%) within 6 months (secondary outcome of the study).…”

Robot-assisted atlantoaxial fixation: illustrative cases

“…Coupling this arm with the use of power tools reduces wobble (deviation of the screw from its intended trajectory), which leads to increased screw purchase and pullout strength. 14 The use of power tools also limits the force applied to this highly mobile area of the spine, which has limited prior use of navigated instrumentation. The decreased movement of the bony elements during instrumentation improves accuracy.…”