Utilization of Magnetic Resonance Imaging-based Synthetic Computed Tomography for Pedicle Screw Navigation in Children: A Feasibility Study

Background: Pedicle screw instrumentation using a fluoroscopy-assisted freehand technique (FAFT) or using navigation based on a preoperative traditional computed tomography (tCT) scan is a common practice. However, concerns remain regarding the long-term effects of repeated ionizing radiation exposure. In 2025, the first pediatric patients in the USA underwent navigated posterior spinal fusions (PSFs) using magnetic resonance imaging (MRI) converted to CT scan-like quality, known as synthetic CT (sCT). The purpo…

By the Truvace deskOctober 16, 20262 min read1 sourcePeer-reviewedTRV-2026-1623· cite & verify

In brief

Researchers reported on 20 children who had posterior spinal fusion in 2025 using MRI converted into CT-like images by a proprietary AI-mediated algorithm, paired with machine-vision image-guided navigation. Their radiation exposure was compared with matched patients who had traditional CT navigation or freehand fluoroscopy-assisted surgery.

The findings matter because concerns persist about long-term effects of repeated ionizing radiation in children undergoing spinal surgery. The study is a feasibility report with a small cohort and retrospective design, so it shows promise for lower-radiation navigation but does not establish long-term benefit or broader safety.

Main points

Mean radiation exposure was 0.90 mGy with synthetic CT versus 5.44 mGy with traditional CT navigation.
Freehand fluoroscopy-assisted cases averaged 7 mGy, making the synthetic CT reduction 87.1%.
Across 335 pedicles instrumented, 13% were difficult type C or D morphology.
The synthetic CT group had no neuromonitoring changes, cerebrospinal fluid leaks, or postoperative neurologic deficits.

The gain

Using synthetic CT made from MRI by an AI-mediated algorithm for navigated pedicle screw placement lowered patient radiation exposure compared with traditional CT navigation and freehand fluoroscopy.

The rundown

The sCT cohort included 20 patients, with 12 (63%) having an idiopathic diagnosis and a mean age at surgery of 13.6 years. Navigation was used across idiopathic, syndromic, congenital, and neuromuscular scoliosis diagnoses.

For comparison, radiation was measured in mGy against 27 patients with traditional CT and navigation and a matched group of 135 patients treated with freehand fluoroscopy-assisted technique by 3 surgeons. Fluoroscopy was still used in sCT cases to confirm T12 and make small alignment adjustments after rod insertion.

The authors classify the evidence as level III, a retrospective cohort study, and describe the work as a feasibility study of the first pediatric patients in the USA treated this way.