# Power-drill fluoroscopy-controlled technique as an alternative to navigation-assisted pedicle screw placement: A propensity score-matched retrospective cohort study

## TL;DR

A power-drill freehand technique for spinal screw placement was found to be as accurate as navigation-assisted methods but with less radiation exposure.

## Contribution

Demonstrates that power-drill fluoroscopy-controlled freehand technique is a viable alternative to navigation-assisted methods in spinal surgery.

## Key findings

- PFH achieved 97.8% satisfactory screw placement compared to 93.5% for NA methods.
- PFH significantly reduced radiation exposure compared to NA techniques.
- Osteoporosis independently reduced screw placement accuracy.

## Abstract

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.

To investigate whether PFH pedicle screw placement achieves comparable accuracy to NA techniques in degenerative thoracolumbar fusion surgery.

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.

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).

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.

•Power-drill freehand technique tested against navigation for spinal screw placement.•Both techniques achieved high accuracy in degenerative thoracolumbar fusion.•Freehand power-drill placement significantly reduced patient radiation exposure.•Screw accuracy was comparable between the power-drill and navigation-assisted methods.•Findings support power-drill freehand as a valid alternative in selected degenerative cases.

Power-drill freehand technique tested against navigation for spinal screw placement.

Both techniques achieved high accuracy in degenerative thoracolumbar fusion.

Freehand power-drill placement significantly reduced patient radiation exposure.

Screw accuracy was comparable between the power-drill and navigation-assisted methods.

Findings support power-drill freehand as a valid alternative in selected degenerative cases.