METHODS article
Front. Surg.
Sec. Orthopedic Surgery
Three-Step Fluoroscopy-Guided Percutaneous Lumbar Pedicle Screw Placement: A Pilot Study on Technical Feasibility, Safety, and Fluoroscopy Reduction
Provisionally accepted
- 1Huazhong University of Science and Technology Tongji Medical College Union Hospital, Wuhan, China
- 2Huazhong University of Science and Technology, Wuhan, China
- 3Henan Luoyang Orthopedic Hospital, Luoyang, China
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BACKGROUND: Minimally invasive surgery has gained widespread popularity in clinical practice. Among spinal surgeries, percutaneous pedicle screw placement (PPS) is one of the most widely performed procedures. However, it necessitates high-frequency fluoroscopic guidance to ensure accuracy, resulting in substantial radiation exposure. Therefore, it is crucial to develop a technique that is fast, safe, and minimizes radiation exposure. OBJECTIVE: We aimed to describe a novel three-step fluoroscopy-guided technique for PPS and preliminarily evaluate the technical feasibility, procedural efficiency, and short-term safety. METHODS: This study prospectively enrolled consecutive patients who underwent PPS using either the three-step fluoroscopy-guided technique or the conventional method from December 2024 to February 2025, while data analysis was performed retrospectively. Data collected included operative time, fluoroscopy frequency, screw placement accuracy, and postoperative complications. RESULTS: The three-step fluoroscopy-guided technique required an average of 4 ± 1.12 fluoroscopic exposures per screw, with an average screw placement time of 5.05 ± 0.923 min. In contrast, the conventional method required an average of 18.33 ± 2.89 fluoroscopic exposures per screw and an average placement time of 15.84 ± 4.11 min. And no significant complications, such as neural or vascular injuries, were reported. CONCLUSION: This pilot study suggests that the three-step fluoroscopy-guided PPS technique is technically feasible and may reduce fluoroscopy usage while maintaining short-term procedural safety, making it a feasible and efficient alternative that warrants further validation in larger cohorts.
Keywords: lumbar disc herniated, lumbar spinal, Lumbar spondylolisthesis, Percutaneous pedicle screw placement, Pilot Study
Received: 07 Oct 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Wu, Jia, Kong and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ke Jia
Chao Chen
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