Power versus manual pedicle tract preparation: a multi-center study of early adopters

Study design Retrospective cohort, multicenter. Summary of background data A single surgeon study demonstrated that pedicle tract preparation with power tools was associated with lower fluoroscopy times and revision rates compared to manual tools, while maintaining patient safety. Objective Our purpose was to determine the safety of power-assisted pedicle tract preparation by early adopters of this technology. Methods Retrospective review comparing patients that underwent posterior spinal fusion by seven pediatric spine surgeons at six institutions between January 1, 2008 and August 31, 2019. The manual pedicle tract preparation used a pedicle awl. Power tract preparation used a flexible 2.0–2.4 mm drill bit, followed by a larger drill bit or a reamer. All screws were inserted with power technique. Results In the manual tract preparation group, 9424 screws were placed in 585 cases. In the power tract preparation group, 22,209 screws were placed in 1367 cases. Seven patients (7/1952; 0.36%; 95% CI: 0.14–0.74%) had 11 mal-positioned screws (11/31,633; 0.03%; 95% CI: 0.017–0.062%). Seven screws (7/9424; 0.07%; 95% CI: 0.030–0.15%) were in the manual cohort and four (4/22,209; 0.02%; 95% CI: 0.0049–0.046%) were in the power cohort. There were significantly more revisions per screw in the manual cohort ( p = 0.02). However, there were not significantly more revisions per patient in the manual cohort (manual: 0.5%, 3/585 vs. power: 0.3%, 4/1,367; p = 0.43). Of these seven, three patients (3/585; 0.5%; 95% CI: 0.1–1.5%) experienced neurologic injury or neuro-monitoring changes requiring screw removal in the manual cohort, and 1 patient (1/1,367, 0.07%; 95% CI: 0.002–0.4%) in the power cohort ( p = 0.08). Three additional patients underwent revision in the power cohort: 1 for an asymptomatic lateral breech, 1 for a spinal headache/medial breech that developed after an MVA, and 1 for an iliac vein injury during pedicle tract preparation. Conclusion This is the first multi-center study examining power pedicle preparation. Overall, 99.9% of pedicle screws placed with power pedicle preparation did not have complications or revision. Equivalent patient safety was demonstrated compared to manual technique. Level of evidence III.