Accuracy of thoracolumbar pedicle screw placement using intraoperative CT navigation versus 3D-printed patient-specific guides integrated with virtual surgical planning: a comparative study

Background 3D-printed patient-specific pedicle screw guides (3DPSG) may provide accuracy comparable to intraoperative CT navigation (CTNav). Our 3DPSG workflow incorporates a virtual surgical planning (VSP) platform that uses deep-learning algorithms to automatically generate pedicle trajectories from CT data.Research design and methods This is a retrospective, single surgeon, single center comparative study of 21 patients undergoing thoracolumbar instrumentation via CTNav (11 patients, 71 screws) and 3DPSG (10 patients, 65 screws). The accuracy was assessed postoperatively using Gertzbein – Robbins and Heary classification systems.Results There were eight men and thirteen women. Gender, BMI, and diagnosis did not differ significantly between the CTNav and 3DPSG groups (p > 0.05). Accuracy was high in both cohorts. By Gertzbein – Robbins, safe placement (grades 0–1) was 97.1% (69/71) with CTNav and 100% (65/65) with 3DPSG. On the Heary system, safe placement (grades 1–2) was 98.6% (70/71) and 100% (65/65), respectively. Malpositions occurred only in the CTNav group (Gertzbein grade 2: 2/71, 2.8%; Heary grade 3: 1/71, 1.4%). Overall accuracy did not differ significantly between groups (Fisher’s exact test, p > 0.05).Conclusions 3DPSG integrated with VSP platform may be a viable alternative navigation system in middle-income settings where intraoperative CTNav is unaffordable.