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Background: In the operative treatment of idiopathic scoliosis, posterior correction and fusion in freehand technique is a proven procedure and is frequently performed. Malpositioned pedicle screws can result in serious neurovascular complications. Intraoperative fluoroscopy and neurophysiological measurements are performed to ensure the correct position of pedicle screws. Newer procedures with fluoroscopic- and computertomographic-assisted navigation are advertised as less dangerous and with a more accurate screw position., Hypothesis: Is the freehand technique used in the surgical treatment of idiopathic scoliosis safer than other methods with regard to complications caused by screw malposition and intraoperative radiation exposure?, Material and Methods: Register data of 34 consecutive idiopathic scoliosis patients with two structural curves (Lenke 3 and 6) were collected prospectively in our scoliosis center and were retrospectively analyzed. The following parameters were evaluated: total radiation product, time of fluoroscopy, number of fused segments, time of operation, blood loss, screw-related complications and number of instrumented pedicle screws. All values were given as mean ± standard deviation and statistically analyzed. Finally, our data were compared on accuracy of screw placement and radiation exposure to data from literature with screw placement under navigation., Results: Average age at the time of surgery was 23.6 ± 12 years. The average thoracic curve was 69.2 ± 14.2° preoperatively and 21.7 ± 12.8° postoperatively (correction 69.9%), the average lumbar curve was 64.3° ± 10.8° preoperatively and corrected to 15.6 ± 10.4° postoperatively (correction 76.2%). The total radiation product per patient was 145.7 ± 86.1 cGy*cm², the time of fluoroscopy 31.7 ± 23.5 s (11.5 segments), the time of operation 267.2 ± 64.1 min and the blood loss 700.4 ± 522.3 ml. A total of 803 pedicle screws were placed. No screw-associated complications were detected in the entire collective. The comparison of our data with freehand placement of pedicle screws to literature data showed a noticeable higher radiation exposure for the patient during fluoroscopic- and computertomographic-assisted navigation., Discussion: The results showed that positioning of pedicle screws with freehand technique in patients with idiopathic scoliosis is accompanied with considerably lower intraoperative radiation exposure compared to fluoroscopic- or computertomographic-assisted navigation. An increased radiation exposure of these typically young patients is associated with an increased long-term risk for the occurrence of radiation-induced malignant diseases. With appropriate surgical experience, placement of pedicle screws in freehand technique is safe and effective and with similar accuracy than screws placed under navigation, but produces significantly less radiation exposure to the patients., Competing Interests: C. Berlin and U. Platz confirm that there are no conflicts of interest. M. Quante has a consultancy contract with the Silony company and receives fees for lectures from Nuvasive Inc. and the Silony company. B. Thomsen does consultancy work for the Silony company. M. Köszegvary has a consultancy contract with the Silony company and receives fees for lectures from Nuvasive Inc. M. Halm has a consultancy contract with, and receives fees for lectures from, Nuvasive Inc. and has a consultancy contract with the Silony company. The Silony company also finances a study leader (study nurse)./C. Berlin und U. Platz geben an, dass kein Interessenkonflikt besteht. M. Quante hat einen Beratervertrag mit der Firma Silony und erhält Honorare für Vorträge von der Firma Nuvasive Inc. sowie der Firma Silony. B. Thomsen hat eine Beratungstätigkeit für die Firma Silony. M. Köszegvary hat einen Beratervertrag mit der Firma Silony und erhält Honorare für Vorträge von der Firma Nuvasive Inc. H. Halm. hat einen Beratervertrag mit Patentvergütungskomponente mit der Firma Nuvasive Inc. sowie einen Beratervertrag mit der Firma Silony. Die Firma Silony finanziert darüber hinaus eine Studienleiterin (study nurse)., (Thieme. All rights reserved.)

Background: A proven and frequently used surgical procedure in patients with idiopathic scoliosis (IS) is posterior transpedicular corrective spondylodesis using the freehand technique. Novel procedures with fluoroscopically and computed tomography (CT)-assisted navigation are presumed to be less risky and more accurate., Objective: Is the freehand technique for IS safe with respect to screw-associated complications and intraoperative radiation exposure?, Material and Methods: Prospectively collected data (2017-2018) from 39 consecutive patients (average age 18.7 years) with thoracic single curvature IS (61.7° ± 13.9°) from a specialized scoliosis center were evaluated for the following parameters (mean ± standard deviation): total radiation product, fluoroscopy time, fused segments, operative time, blood loss and screw-associated complications. A comparison with data from the literature on intraoperative radiation exposure using navigation procedures was carried out., Results: The total radiation product per patient was 71.7 ± 44.0 cGy*cm 2 , fluoroscopy time 17.4 ± 8.6 s. (7.8 segments), operative time 183.5 ± 54.2 min and blood loss 379.5 ± 183 ml. There were no screw-associated complications in the entire collective. Correction of the main curvature was 75.7%. Comparison of the data with index data from the literature showed a 1.25-12.5-fold higher radiation exposure for patients with fluoroscopically assisted navigation and 9.25-12.3-fold higher radiation exposure with CT-assisted procedures compared to the present results., Conclusion: The results of this study showed that with appropriate experience freehand positioning of pedicle screws is associated with comparable accuracy and less radiation exposure for patients than navigation procedures. With respect to the young age of patients, a radiation-induced long-term risk for malignant diseases should be taken into consideration.