Lumbar and sacral pedicle screw placement using a template does not improve the midterm pain and disability outcome in comparison with free-hand method.

Abstract

The free-hand technique carries a higher risk of pedicle weakening and neurovascular injuries in comparison with pedicle screw placement using a drill guide. Due to this evidence and because of some variances in the surgical method, different outcome can be expected. The objective of the study was to evaluate the disability, the back and leg pain before and at least 3 years after the surgery between examined groups. Eleven patients in drill guide and 13 in control group were randomly assigned for vertebral fusion in the lumbar and first sacral regions. Pre- and post-operative CT scans, Oswestry disability index (ODI) and visual analogue scale (VAS) for back and leg pain were taken. Post-operative evaluations of cortex perforation and statistical analysis between studied groups have been performed. Seventy-two screws were inserted in each group. All patients completed a 3-year follow-up. Comparing groups, there was no statistical significant difference in VAS and ODI before or after surgery. Cortex perforation incidence in drill guide group was 6 and in free-hand group 29 (p < 0.05). In each group, pain and disability were significantly lower as before the procedure. The application of a drill guide template for pedicle screw placement is not more effective in reducing pain and disability after midterm follow-up in comparison with the free-hand technique. However, it reduces the cortex perforation incidence. Concerning this evidence, a drill guide is still an additional tool that could in the future potentially compete with other screw placement techniques.