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Comparative Study
. 2025 Nov;13(6):1789-1798.
doi: 10.1007/s43390-025-01138-4. Epub 2025 Jul 5.

Turning the screw: assessing the impact of full power-assisted versus manual pedicle screw insertion in paediatric spine surgery

Weronika Nocun  1   2 , Neel Badhe  3 , Vasanth Bharathidasan  4 , Gayathri Vimal  4 , Kalyani Parvathi Nair  4 , Elie Najjar  5
Affiliations
Comparative Study

Turning the screw: assessing the impact of full power-assisted versus manual pedicle screw insertion in paediatric spine surgery

Weronika Nocun et al. Spine Deform. 2025 Nov.

Abstract

Background: Long-level pedicle screw placement involves repetitive, forceful rotational movements that increase the risk of musculoskeletal pain and disorders in spine surgeons. Full power-assisted pedicle screw insertion may mitigate these risks, but its efficacy and safety compared to manual techniques remain underexplored. Understanding these differences is crucial for optimizing surgical practices and improving outcomes.

Objective: To systematically evaluate the outcomes of full power-assisted versus manual pedicle screw insertion in paediatric spine surgery, focusing on operative time and complications.

Methods: A systematic review of English-language literature published up to September 2024 was conducted using the search criteria ("Pedicle Screws"[Mesh]) and (power), adhering to PRISMA guidelines. Studies comparing full power-assisted and manual pedicle screw insertion were included.

Results: Of 2,559 patients, 1,715 underwent full power-assisted insertion (65.7% female, mean age 14.3 years, mean follow-up 20.8 months), and 844 underwent manual insertion (67.9% female, mean age 14.5 years, mean follow-up 26.9 months). Operative times were comparable (248 vs. 251.4 min, p = 0.69), as were screw breach rates (0.49% vs. 1.42%, p = 0.23). However, manual insertion was associated with a significantly higher rate of other complications compared to full power-assisted techniques (0.077% vs. 0.022%, p = 0.03).

Conclusion: Full power-assisted pedicle screw insertion is as efficient and accurate as manual techniques, with fewer complications in pedicle screw placement surgery. These findings support the use of power assistance to enhance surgical safety. Further research should validate these results in diverse patient populations and long-term follow-up.

Keywords: Manual pedicle screw insertion; Pedicle screw placement; Power-assisted pedicle screw insertion; Scoliosis; Surgeon injury.

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Conflict of interest statement

Declarations. Competing interests: The authors have no relevant financial or non-financial interests to disclose. Ethics approval: The study does not require Ethical approval due to the systematic review design of the study. Informed consent: Not applicable.

Figures

Fig. 1
Fig. 1
Figure illustrating the PRISMA chart for this systematic review
Fig. 2
Fig. 2
Figure detailing the operative time, screw breaches, and complications for patients with AIS
Fig. 2
Fig. 2
Figure detailing the operative time, screw breaches, and complications for patients with AIS
See this image and copyright information in PMC

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