TY - JOUR
T1 - Accuracy of Current Techniques for Placement of Pedicle Screws in the Spine
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 L.
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/6
Y1 - 2019/6
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.
KW - Accuracy
KW - Fluoroscopy
KW - Freehand
KW - Navigation
KW - Pedicle Screw
KW - Robot
UR - http://www.scopus.com/inward/record.url?scp=85064248045&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064248045&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2019.02.217
DO - 10.1016/j.wneu.2019.02.217
M3 - Review article
C2 - 30880208
AN - SCOPUS:85064248045
SN - 1878-8750
VL - 126
SP - 664-678.e3
JO - World neurosurgery
JF - World neurosurgery
ER -