{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T04:11:09Z","timestamp":1783915869021,"version":"3.55.0"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","license":[{"start":{"date-parts":[[2021,8,1]],"date-time":"2021-08-01T00:00:00Z","timestamp":1627776000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Patient-specific template-guided (TG) pedicle screw placement currently achieves the highest reported accuracy in cadaveric and early clinical studies, with reports of reduced use of radiation and less surgical time. However, a clinical randomized controlled trial (RCT) eliminating potential biases is lacking. This study compares TG and standard freehand (FH) pedicle screw insertion techniques in an RCT.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Twenty-four patients (mean age 64 years, 9 men and 15 women) scheduled consecutively and independently from this study for 1-, 2-, or 3-level lumbar fusion were randomized to either the FH (n = 12) or TG (n = 12) group. Accuracy of pedicle screw placement, intraoperative parameters, and short-term complications were compared.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 112 screws (58 FH and 54 TG screws) were implanted in the lumbar spine. Radiation exposure was significantly less in the TG group (78.0 \u00b1 46.3 cGycm<jats:sup>2<\/jats:sup>) compared with the FH group (234.1 \u00b1 138.1 cGycm<jats:sup>2<\/jats:sup>, p = 0.001). There were 4 pedicle screw perforations (6.9%) in the FH group and 2 (3.7%) in the TG group (p &gt; 0.99), with no clinical consequences. Clinically relevant complications were 1 postoperative pedicle fracture in the FH group (p &gt; 0.99), 1 infection in the FH group, and 2 infections in the TG group (p &gt; 0.99). There were no significant differences in surgical exposure time, screw insertion time, overall surgical time, or blood loss between the FH and TG groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>In this RCT, patient-specific TG pedicle screw insertion in the lumbar region achieved a high accuracy, but not better than a standardized FH technique. Even if intraoperative radiation exposure is less with the TG technique, the need for a preoperative CT scan counterbalances this advantage. However, more difficult trajectories might reveal potential benefits of the TG technique and need further research.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2020.10.spine201383","type":"journal-article","created":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T07:23:13Z","timestamp":1622186593000},"page":"147-153","source":"Crossref","is-referenced-by-count":9,"title":["Patient-specific template-guided versus standard freehand lumbar pedicle screw implantation: a randomized controlled trial"],"prefix":"10.3171","volume":"35","author":[{"given":"Jos\u00e9 Miguel","family":"Spirig","sequence":"first","affiliation":[{"name":"Spine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayan","family":"Golshani","sequence":"additional","affiliation":[{"name":"Spine and"},{"name":"Neurosurgical Division, Kantonsspital Graub\u00fcnden Hauptstandort, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadja A.","family":"Farshad-Amacker","sequence":"additional","affiliation":[{"name":"Radiology Divisions, Balgrist University Hospital, University of Zurich; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazda","family":"Farshad","sequence":"additional","affiliation":[{"name":"Spine and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1007\/BF01676569","article-title":"Pedicle screw fixation in spinal disorders: a European view","volume":"6","author":"Boos N","year":"1997","unstructured":"Boos N, Webb JK. 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