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

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 (8,378±5,302 vs 23,793±13,162 mGy·cm 2 ; p