Accuracy of Free-Hand Pedicle Screws in the Thoracic and Lumbar Spine: Analysis of 6816 Consecutive Screws

Abstract

Free-hand pedicle screw placement based on external anatomy alone can be performed with acceptable safety and accuracy and allows avoidance of radiation exposure encountered in fluoroscopic techniques. Image-guided assistance may be most valuable when placing screws between T4 and T6, where breach rates are highest.