Clinical Outcome and Radiological Accuracy of the Free Hand Surgical Technique for Screw Placement in Cervical and Dorsolumbr Spine

Abstract

Introduction: Pedicle screw fixation is a commonly accepted method for attaining stable posterior spinal stabilization; however, concerns about accuracy, neurovascular safety, and radiation exposure associated with image-guided techniques remain to highlight the importance of reliable freehand screw placement on the basis of anatomical landmarks.

Objective: To assess the clinical effectiveness and outcomes of freehand pedicle screw fixation for treating dorsal, lumbar and sacral fractures at a tertiary care center in Pakistan.

Methods: Retrospective reviews were conducted for 150 consecutive patients who underwent freehand pedicle screw fixation for thoracic, lumbar, and sacral spinal fractures at a tertiary care center between January 2021 and December 2022 in Pakistan. In total, 911 pedicle screws were inserted via anatomical landmarks alone, and the accuracy of screw placement and degree of cortical breach were assessed intraoperatively and on postoperative radiographs and/or computed tomography (CT) scans.

Results: Overall, 887 screws (97.4%) were classified as acceptable. Acceptable placement was achieved for 69 of 70 cervical screws (98.6%), 169 of 174 thoracic screws (97.1%), and 630 of 637 lumbar screws (98.9%). In contrast, sacral screw placement demonstrated lower accuracy, with 19 of the 30 screws (63.3%) deemed acceptable. No neurological or vascular complications were observed.

Conclusion: Freehand pedicle screw placement based on anatomical landmarks demonstrated high accuracy and a low complication rate across the thoracic, lumbar, and sacral spinal levels. With meticulous surgical techniques and appropriate preoperative planning, freehand fixation remains a safe and effective method, particularly in settings where advanced navigation technologies are not readily available.

Keywords: Freehand technique, Pedicle screw fixation, Spinal fracture.