Accuracy of Current Techniques for Placement of Pedicle Screws in the Spine: A Comprehensive Systematic Review and Meta-Analysis of 51,161 Screws

Alexander Perdomo-Pantoja, Wataru Ishida, Corinna Zygourakis, Christina Holmes, Rajiv R. Iyer, Ethan Cottrill, Nicholas Theodore, Timothy F Witham, Sheng-fu Lo

Research output: Contribution to journalReview article

Abstract

Background: Pedicle screws (PSs) are routinely used for stabilization to enhance fusion in a variety of spinal diseases. Although the accuracy of different PS placement methods has been previously reported, most of these studies have been limited to 1 or 2 techniques. The purpose was to determine the current accuracy of PS placement among 4 modalities of PS insertion (freehand [FH], fluoroscopy-assisted [FA], computed tomography navigation–guided [CTNav], and robot-assisted [RA]) and analyze variables associated with screw misplacement. Methods: A systematic review was performed of peer-reviewed articles reporting PS accuracy of 1 technique from January 1990 to June 2018. Accuracy of PS placement, PS insertion technique, and pedicle breach (PB) data were collected. A meta-analysis was performed to estimate the overall pooled (OP) rates of PS accuracy as a primary outcome, stratified by screw insertion techniques. Potential determinants were analyzed via meta-regression analyses. Results: Seventy-eight studies with 7858 patients, 51,161 PSs, and 3614 cortical PBs were included. CTNav showed the highest PS placement accuracy compared with other techniques: OP accuracy rates were 95.5%, 93.1%, 91.5%, and 90.5%, via CTNav, FH, FA, and RA techniques, respectively. RA and CTNav were associated with the highest PS accuracy in the thoracic spine, compared with FH. Conclusions: The OP data show that CTNav has the highest PS accuracy rates. Thoracic PSs were associated with lower accuracy rates; however, RA showed fewer breaches in the thoracic spine compared with FH and FA. Given the heterogeneity among studies, further standardized and comparative investigations are required to confirm our findings.

Original languageEnglish (US)
JournalWorld neurosurgery
DOIs
StatePublished - Jan 1 2019

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Meta-Analysis
Spine
Tomography
Fluoroscopy
Thorax
Pedicle Screws
Spinal Diseases
Regression Analysis

Keywords

  • Accuracy
  • Fluoroscopy
  • Freehand
  • Navigation
  • Pedicle Screw
  • Robot

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Accuracy of Current Techniques for Placement of Pedicle Screws in the Spine : A Comprehensive Systematic Review and Meta-Analysis of 51,161 Screws. / Perdomo-Pantoja, Alexander; Ishida, Wataru; Zygourakis, Corinna; Holmes, Christina; Iyer, Rajiv R.; Cottrill, Ethan; Theodore, Nicholas; Witham, Timothy F; Lo, Sheng-fu.

In: World neurosurgery, 01.01.2019.

Research output: Contribution to journalReview article

@article{7b0a04f003d64e55bd5e964315737160,
title = "Accuracy of Current Techniques for Placement of Pedicle Screws in the Spine: A Comprehensive Systematic Review and Meta-Analysis of 51,161 Screws",
abstract = "Background: Pedicle screws (PSs) are routinely used for stabilization to enhance fusion in a variety of spinal diseases. Although the accuracy of different PS placement methods has been previously reported, most of these studies have been limited to 1 or 2 techniques. The purpose was to determine the current accuracy of PS placement among 4 modalities of PS insertion (freehand [FH], fluoroscopy-assisted [FA], computed tomography navigation–guided [CTNav], and robot-assisted [RA]) and analyze variables associated with screw misplacement. Methods: A systematic review was performed of peer-reviewed articles reporting PS accuracy of 1 technique from January 1990 to June 2018. Accuracy of PS placement, PS insertion technique, and pedicle breach (PB) data were collected. A meta-analysis was performed to estimate the overall pooled (OP) rates of PS accuracy as a primary outcome, stratified by screw insertion techniques. Potential determinants were analyzed via meta-regression analyses. Results: Seventy-eight studies with 7858 patients, 51,161 PSs, and 3614 cortical PBs were included. CTNav showed the highest PS placement accuracy compared with other techniques: OP accuracy rates were 95.5{\%}, 93.1{\%}, 91.5{\%}, and 90.5{\%}, via CTNav, FH, FA, and RA techniques, respectively. RA and CTNav were associated with the highest PS accuracy in the thoracic spine, compared with FH. Conclusions: The OP data show that CTNav has the highest PS accuracy rates. Thoracic PSs were associated with lower accuracy rates; however, RA showed fewer breaches in the thoracic spine compared with FH and FA. Given the heterogeneity among studies, further standardized and comparative investigations are required to confirm our findings.",
keywords = "Accuracy, Fluoroscopy, Freehand, Navigation, Pedicle Screw, Robot",
author = "Alexander Perdomo-Pantoja and Wataru Ishida and Corinna Zygourakis and Christina Holmes and Iyer, {Rajiv R.} and Ethan Cottrill and Nicholas Theodore and Witham, {Timothy F} and Sheng-fu Lo",
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T2 - A Comprehensive Systematic Review and Meta-Analysis of 51,161 Screws

AU - Perdomo-Pantoja, Alexander

AU - Ishida, Wataru

AU - Zygourakis, Corinna

AU - Holmes, Christina

AU - Iyer, Rajiv R.

AU - Cottrill, Ethan

AU - Theodore, Nicholas

AU - Witham, Timothy F

AU - Lo, Sheng-fu

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N2 - Background: Pedicle screws (PSs) are routinely used for stabilization to enhance fusion in a variety of spinal diseases. Although the accuracy of different PS placement methods has been previously reported, most of these studies have been limited to 1 or 2 techniques. The purpose was to determine the current accuracy of PS placement among 4 modalities of PS insertion (freehand [FH], fluoroscopy-assisted [FA], computed tomography navigation–guided [CTNav], and robot-assisted [RA]) and analyze variables associated with screw misplacement. Methods: A systematic review was performed of peer-reviewed articles reporting PS accuracy of 1 technique from January 1990 to June 2018. Accuracy of PS placement, PS insertion technique, and pedicle breach (PB) data were collected. A meta-analysis was performed to estimate the overall pooled (OP) rates of PS accuracy as a primary outcome, stratified by screw insertion techniques. Potential determinants were analyzed via meta-regression analyses. Results: Seventy-eight studies with 7858 patients, 51,161 PSs, and 3614 cortical PBs were included. CTNav showed the highest PS placement accuracy compared with other techniques: OP accuracy rates were 95.5%, 93.1%, 91.5%, and 90.5%, via CTNav, FH, FA, and RA techniques, respectively. RA and CTNav were associated with the highest PS accuracy in the thoracic spine, compared with FH. Conclusions: The OP data show that CTNav has the highest PS accuracy rates. Thoracic PSs were associated with lower accuracy rates; however, RA showed fewer breaches in the thoracic spine compared with FH and FA. Given the heterogeneity among studies, further standardized and comparative investigations are required to confirm our findings.

AB - Background: Pedicle screws (PSs) are routinely used for stabilization to enhance fusion in a variety of spinal diseases. Although the accuracy of different PS placement methods has been previously reported, most of these studies have been limited to 1 or 2 techniques. The purpose was to determine the current accuracy of PS placement among 4 modalities of PS insertion (freehand [FH], fluoroscopy-assisted [FA], computed tomography navigation–guided [CTNav], and robot-assisted [RA]) and analyze variables associated with screw misplacement. Methods: A systematic review was performed of peer-reviewed articles reporting PS accuracy of 1 technique from January 1990 to June 2018. Accuracy of PS placement, PS insertion technique, and pedicle breach (PB) data were collected. A meta-analysis was performed to estimate the overall pooled (OP) rates of PS accuracy as a primary outcome, stratified by screw insertion techniques. Potential determinants were analyzed via meta-regression analyses. Results: Seventy-eight studies with 7858 patients, 51,161 PSs, and 3614 cortical PBs were included. CTNav showed the highest PS placement accuracy compared with other techniques: OP accuracy rates were 95.5%, 93.1%, 91.5%, and 90.5%, via CTNav, FH, FA, and RA techniques, respectively. RA and CTNav were associated with the highest PS accuracy in the thoracic spine, compared with FH. Conclusions: The OP data show that CTNav has the highest PS accuracy rates. Thoracic PSs were associated with lower accuracy rates; however, RA showed fewer breaches in the thoracic spine compared with FH and FA. Given the heterogeneity among studies, further standardized and comparative investigations are required to confirm our findings.

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KW - Freehand

KW - Navigation

KW - Pedicle Screw

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