CORR Insights®: Increased Radiation but No Benefits in Pedicle Screw Accuracy With Navigation versus a Freehand Technique in Scoliosis Surgery

i) Study design: Review article.
ii) CT-based navigation generally improves pedicle screw placement accuracy, but it significantly increases radiation exposure, sometimes exceeding the lifetime exposure seen in long-term scoliosis monitoring.
iii) Navigation shows accuracy benefits in lumbar regions and complex deformities, while freehand techniques perform equally well or better in thoracic regions and among experienced surgeons treating moderate scoliosis.
iv) Standardization of breach grading, stratified studies by age, deformity type, and spinal region, and the development of lower-dose CT protocols are essential to clarify when the benefits of CT navigation outweigh its risks and justify its clinical use.

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