A novel guide device for pedicle screw insertion using three-dimensional preoperative planning in open lumbar spinal surgery: a comparative retrospective study

Pedicle screw stabilization (PSS) surgeries for spinal instability are still the most effective treatment approach. The use of preoperative planning can minimize the complications related to transpedicular screw (TPS) misplacement. The study aimed to evaluate the surgical outcomes of a guide device developed to improve the accuracy of the free-hand technique using three-dimensional planning in PSS. Patients with degenerative spinal diseases who underwent open PSS between 2019 and 2022 were evaluated retrospectively. FG group included patients who were operated on using the fluoroscopy alone with preoperative two-dimensional planning. AFG group included patients who were operated on using a guide advice-assisted technique with preoperative 3DP. Between-group comparisons were performed. A total of 143 patients with a mean age of 59.6 years were included in the study. 71 patients were assessed in the FG group and 72 patients in the AFG group. Between-group comparisons regarding demographics, etiologies, radiation exposure, and functional improvements showed no significant differences (<i>p</i> &gt; 0.05). Although the accuracy of TPSs positioning was 94.2% and 96.5% in the 2DG and 3DG, the difference between the groups was not statistically significant. The statistically significant differences regarding the upper-level facet joint violation and pedicle breach rates were lower in the AFG group (<i>p</i> &lt; 0.0001; X² = 19.57) and (<i>p</i> &lt; 0.0001; X² = 25.3), respectively. Using a guide device associated with preoperative 3PD reduced the upper-level facet joint violation and pedicle breach rates in open PSS surgeries performed by free-hand technique for degenerative spinal diseases.