Guidewireless awl technique offers highly time-efficient alternative for navigated pedicle screw insertion in spine surgeries: study

Pedicle screw fixation is a cornerstone of spinal fusion surgery due to its superior biomechanical stability. While conventional Kirschner wire (K-wire)-guided techniques are widely used, they involve multiple steps and are associated with specific complications. The introduction of the tip-tap awl allows for a guidewireless, single-pass insertion technique, potentially improving surgical efficiency while maintaining accuracy.

Dave et al conducted a retrospective analysis on patients who underwent minimally invasive spine surgery (MISS) with navigated pedicle screw (Medtronic, Littleton, USA) insertion at a single tertiary center. Two navigated techniques were compared: the conventional K-wire-guided method and a guidewireless method using a navigated tip-tap awl (Medtronic, Minneapolis, USA). Data on intraoperative workflow, screw insertion time, complications, and breach rates were collected and analyzed. The article has been published in ‘Cureus’ journal.

The key findings of the study were:

• A total of 488 screws were evaluated in 122 patients (51 male, 71 female).

• Patient age ranged from 19 to 85 years.

• Screws were placed using either the guidewire method (56 patients) or the guidewireless method (66 patients).

• In total, two screws were placed in L2, 24 in L3, 182 in L4, 220 in L5, and 60 in S1.

• Both groups showed high accuracy, with minimal breach rates and no clinically significant postoperative complications.

• The average time per screw was 5.68 minutes for guidewire surgery and 4.38 minutes for guidewireless surgery.

• The guidewireless method required fewer procedural steps and demonstrated an average reduction in screw insertion time of 1.30 minutes per screw.

“In conclusion, observational data from this retrospective cohort suggest the guidewireless tip-tap awl technique offers a highly time-efficient alternative for navigated pedicle screw insertion. By reducing procedural steps, it streamlines the MISS workflow without apparent compromise in accuracy. However, while complication and breach rates were minimal, this cohort is underpowered to definitively establish safety non-inferiority. Future prospective randomized controlled trials are necessary to confirm these findings and draw definitive causal comparisons” – the authors commented.

For further details on the article refer to:

Dave M B, Panthackel M, Dave B R, et al. (April 23, 2026) A Retrospective Analysis of Guidewireless Versus Guidewire-Assisted Navigated Percutaneous Pedicle Screw Placement for Minimally Invasive Spine Surgery at a Tertiary Care Institute. Cureus 18(4): e107567. DOI 10.7759/cureus.107567