Patient-specific 3D template with radiopaque markers for pediatric pedicle screw fixation: comparison with freehand technique

BACKGROUND: Accuracy and precision are crucial in pedicle screw implantation in children with congenital spinal deformities combined with thoracic cage anomalies. The use of patient-specific navigation templates supplemented with radiopaque markers significantly improves screw positioning accuracy and reduces the risk of complications. AIM: To evaluate the effectiveness of a novel patient-specific surgical template with radiopaque markers and accuracy of pedicle screw placement in children with congenital spinal deformities combined with thoracic cage anomalies, compared with the freehand technique. METHODS: The study included 26 patients (aged 4–9 years) who underwent surgery at a specialized center. The patients were grouped into two: group 1 (n = 13) underwent screw placement using the new template with radiopaque markers and group 2 (n = 13) underwent screw placement using the freehand technique. Screw placement accuracy was evaluated using the Gertzbein scale based on postoperative radiographs and computed tomography. Statistical analysis was performed using the Student’s t-test, with p 0.05 indicating significance. RESULTS: In the navigation template group, 100% of screws were placed correctly (grade 0). In the freehand group, 80.5% of screws were correctly positioned; 16.9% showed deviations up to 2 mm (grade 1), and 2.6% showed deviations 2 mm (grade 2). The use of the navigation template significantly reduced the time required for bone canal preparation compared with the freehand method. CONCLUSION: Navigation templates with radiopaque markers demonstrate high accuracy and correctness in pedicle screw placement in children with congenital spinal deformities, reducing malposition risk and shortening operative time. Their widespread implementation may enhance the safety and effectiveness of surgical treatment in this patient population.