We would like to thank Dr Greenberg and colleagues for their enthusiastic readership of our work. When writing this systematic review and meta-analysis we anticipated this would be a contentious topic. It is not our intention to imply that freehand screws are unsafe or below the standard of care. Let us state now and unequivocally that freehand screws are safe and effective and well within the standard of care. The decision to use navigated or robotic screws is one which should depend on patient characteristics and the surgeon's level of comfort with these techniques. There will always be a place for freehand screws and knowing how to anatomically place freehand screws is essential to knowing how to use navigation and robotics effectively. However, we felt that the results of our meta-analysis could not be ignored. As Dr Greenberg and colleagues alluded to, the technology in place for robotic and navigated screws will continue to advance and improve over time. Contrary to prior meta-analysis of this topic, we found that robotic and navigated screws were either equivalent to or superior to freehand screws in accuracy and complications.
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Published online: April 21, 2023
Accepted: April 11, 2023
Received: April 7, 2023
Publication stageIn Press Journal Pre-Proof
FDA device/drug status: Not applicable.
Author disclosures: AVM: Nothing to disclose. OA: Nothing to disclose.
© 2023 Elsevier Inc. All rights reserved.
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- Letter to the editor regarding “robotic and navigated pedicle screws are safer and more accurate than fluoroscopic freehand screws: a systematic review and meta-analysis”The Spine Journal
- PreviewWe appreciate the efforts by Matur and colleagues  to systematically review the evidence regarding fluoroscopic freehand versus navigated pedicle screw placement. With the growth in spine fusion surgery , safe instrumentation placement is an area of increasing importance. The authors should be congratulated for their efforts. Nonetheless, we believe there are several shortcomings that should temper the authors’ conclusions and their impact on clinical practice.