• Clara Berlin, Markus Quante, Bjoern Thomsen, Mark Koeszegvary, Uwe Platz, David Ivanits, and Henry Halm.
• Spine Surgery with Scoliosis Center, Schoen Clinic Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany. CBerlin@schoen-klinik.de.
• Eur Spine J. 2020 Aug 1; 29 (8): 2036-2045.

PurposeIn surgical correction of scoliosis with pedicle screw dual-rod systems, frequently used freehand technique of screw positioning is challenging due to 3D deformity. Screw malposition can be associated with serious complications. Image-guided technologies are already available to improve accuracy of screw positioning and decrease radiation to surgeon. This study was conducted to measure intraoperative radiation to patients in freehand technique, evaluate screw-related complications and compare radiation values to published studies using navigation techniques.MethodsRetrospective analysis of prospectively collected data of 73 patients with idiopathic scoliosis, who underwent surgical correction with pedicle screw dual-rod system. Evaluated parameters were age, effective radiation dose (ED), fluoroscopy time, number of fused segments, correction and complications. Parameters were compared with regarding single thoracic curve (SC) and double thoracic and lumbar curves (DC), adolescent (10-18 years) or adult (> 18 years) idiopathic scoliosis, length of instrumentation. ED was compared with values for navigation from online database.ResultsAverage age was 21.0 ± 9.7 years, ED was 0.17 ± 0.1 mSv, time of fluoroscopy was 24.1 ± 18.6 s, 9.5 ± 1.9 fused segments. Average correction for SC was 75.7%, for DC 69.9% (thoracic) and 76.2% (lumbar). No screw-related complications. ED was significantly lower for SC versus DC (p < 0.01), short versus long fusions (p < 0.01), no significant difference for age (p = 0.1). Published navigation data showed 6.5- to 8.8-times higher radiation exposure for patients compared to our results.ConclusionCompared to navigation procedures, freehanded positioning of pedicle screws in experienced hands is a safe and effective method for surgical correction of idiopathic scoliosis with a significant decrease in radiation exposure to patients.

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