# Three-step fluoroscopy-guided percutaneous lumbar pedicle screw placement: a pilot study on technical feasibility, safety, and fluoroscopy reduction

## TL;DR

A new three-step technique for placing spinal screws reduces radiation exposure and is as safe as traditional methods, according to a pilot study.

## Contribution

A novel three-step fluoroscopy-guided method for percutaneous pedicle screw placement is introduced and evaluated.

## Key findings

- The three-step technique used 4 ± 1.12 fluoroscopic exposures per screw, compared to 18.33 ± 2.89 with the conventional method.
- Screw placement time was significantly shorter with the new technique (5.05 ± 0.923 min vs. 15.84 ± 4.11 min).
- No major complications were reported with the three-step method.

## Abstract

Minimally invasive surgery has gained widespread popularity in clinical practice. Among spinal surgeries, percutaneous pedicle screw placement (PPS) is one of the most widely performed procedures. However, it necessitates high-frequency fluoroscopic guidance to ensure accuracy, resulting in substantial radiation exposure. Therefore, it is crucial to develop a technique that is fast, safe, and minimizes radiation exposure.

We aimed to describe a novel three-step fluoroscopy-guided technique for PPS and preliminarily evaluate the technical feasibility, procedural efficiency, and short-term safety.

This study prospectively enrolled consecutive patients who underwent PPS using either the three-step fluoroscopy-guided technique or the conventional method from December 2024 to February 2025, while data analysis was performed retrospectively. Data collected included operative time, fluoroscopy frequency, screw placement accuracy, and postoperative complications.

The three-step fluoroscopy-guided technique required an average of 4 ± 1.12 fluoroscopic exposures per screw, with an average screw placement time of 5.05 ± 0.923 min. In contrast, the conventional method required an average of 18.33 ± 2.89 fluoroscopic exposures per screw and an average placement time of 15.84 ± 4.11 min. And no significant complications, such as neural or vascular injuries, were reported.

This pilot study suggests that the three-step fluoroscopy-guided PPS technique is technically feasible and may reduce fluoroscopy usage while maintaining short-term procedural safety, making it a feasible and efficient alternative that warrants further validation in larger cohorts.