Trials that fail to show advantages of 3D navigation in spine surgery—is it the technology or the trial?

Ruatti et al. have published a randomized study comparing computer-navigated and conventional pedicle screw placement. It was a single-center study although with six different surgeons. The procedures were also divided into open and percutaneous, although allocation was not randomized and presumably was up to the surgeon. The percutaneous group also included vertebroplasty/kyphoplasty procedures, in addition to screw placement. The outcome measures were: (I) screw malposition rates; (II) screw insertion time; and (III) radiation exposure.