ArticleCureus2025
Accuracy of Lumbar Pedicle Screw Placement Based on Insertion Techniques in a Single-Center Retrospective Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAlthough many studies have evaluated the accuracy of pedicle screw (PS) placement using various techniques, few have conducted large-scale comparisons of open and percutaneous approaches using CT navigation and fluoroscopy within a single institution. This study aimed to evaluate the accuracy of lumbar PS placement based on four different insertion techniques and to identify factors influencing screw placement accuracy.
methodsA total of 237 cases (1,081 screws) of PS placement at the L1-S1 level were retrospectively analyzed. Patients were divided into four groups: open CT navigation, percutaneous PS (PPS) CT navigation, PPS fluoroscopy, and open freehand. Screw accuracy was assessed using the Gertzbein-Robbins classification based on postoperative CT or intraoperative O-arm images. The proportions of grade A (no breach) and grade A or B (≤2 mm breach) screws were compared among the groups. Statistical analyses included Fisher's exact test with Bonferroni correction.
resultsThe proportion of grade A screws was highest in the open CT navigation group (96.4%), followed by PPS fluoroscopy (89.3%), open freehand (88.0%), and PPS CT navigation (81.0%) (p < 0.05). Grade A or B screws exceeded 95% in all groups with no significant differences. Lateral breaches were the most frequent, particularly in the PPS CT navigation (93.3%) and PPS fluoroscopy (82.0%) groups. No grade D or E medial or caudal breaches or neurological complications were observed. Screw repositioning was required in two cases (three screws) due to lateral breaches >4 mm with screw tips located outside the vertebral body.
conclusionsAll four insertion techniques achieved high accuracy, with more than 95% of screws classified as acceptable placements and no neurological complications observed. These findings suggest that lumbar PS placement can be performed safely and reliably across different techniques when applied appropriately.
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