Enabling Technologies for Pedicle Screw Placement in Pediatric Spine Surgery

Enabling technologies (ETs) have increasingly been developed and used in pediatric spine surgery over the past two decades, sparking ongoing discussion about their benefits and drawbacks. Relevant literature indicates that ETs can enhance pedicle screw safety and accuracy while decreasing radiation exposure to patients and surgical staff. However, steep learning curves initially lead to longer operative times, and the costs of implementing these technologies are significant. This review explores current ETs for pediatric pedicle screw placement, assessing their utility, advantages, limitations, and practical considerations for adoption. Technologies discussed include stereotactic navigation, machine-vision navigation, robotic systems, and 3D-printed modeling systems used for pedicle screw placement. The article evaluates pedicle screw accuracy, surgical procedure time and complications, radiation exposure, surgeon safety, learning curves, costs, and technological limitations. Key Concepts: (1) ET methods for pedicle screw placement in pediatric spine surgery include stereotactic navigation, machine-vision navigation, robotic assistance, and 3D-printed drill guides. (2) Implementing ETs in pediatric spine surgery can extend operative times and bring new challenges, including high initial costs, a steep learning curve, and technical difficulties. (3) Gaining proficiency in ETs may eventually decrease operative time, improve pedicle screw placement accuracy, facilitate education, and support surgeon well-being. (4) ETs may provide significant value in complex pediatric cases with severe deformities, small pedicles, and/or challenging anatomy. (5) Ideally, best practices can be achieved through collaboration with colleagues.