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Abstract Spinal fixation is a worldwide procedure that is used in the treatment of different spinal diseases including trauma, deformity, degenerative disease, and tumor. Accurate pedicle screws insertion is crucial to achieve a safe and rigid fixation. Misplaced screws may cause injury to vital structures or lead to failure of fixation. It can also be life-threatening for the patients or cause permanent neurological damage. Many studies have reported high rates of screw misplacement associated with freehand technique (up to 30% in some cases). Moreover, freehand technique requires extensive use of fluoroscopy, which leads to high radiation exposure for patients and surgical teams. Radiation dose has attracted a lot of attention after the reported high frequency of tumors among spinal surgeons. |