Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients

Laine, Timo; Lund, Teija; Ylikoski, Mauno; Lohikoski, Jouni; Schlenzka, Dietrich

doi:10.1007/s005860000146

Cited by 494 publications

(345 citation statements)

References 14 publications

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“…Of these, 46 were excluded because they were case series. The remaining 43 papers [11-51, 54, 55] [18,23,37], 4 prospective comparative studies [22,25,27,29] and 21 retrospective comparative studies [12-17, 19-21, 24, 26, 28, 30-36, 38, 55].…”

Section: Resultsmentioning

confidence: 99%

Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

et al. 2010

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Studies revealed that navigation systems that provided intraoperative assistance might improve pedicle screw insertion accuracy, and also implied that different systems provided different pedicle screw insertion accuracy. A systematic review and meta-analysis was conducted to focus on the pedicle screw insertion accuracy with or without the assistance of image-guided system, and the variance among the different navigation systems. Comparative studies were searched on pedicle screw insertion accuracy between conventional and navigated method, and among different navigation systems. A total of 43 papers, including 28 clinical, 14 cadaveric and 1 model studies, were included in the current study. For clinical articles, there were 3 randomized clinical trials, 4 prospective comparative studies and 21 retrospective comparative studies. The incidence of pedicle violation among computer tomography-based navigation method group was statistically significantly less than that observed among the conventional group (OR 95% CI, in vivo: 0.32-0.60; in vitro: 0.24-0.75 P \ 0.01). Two-dimensional fluoroscopybased navigation system (OR 95% CI, in vivo: 0.27-0.48; in vitro: 0.43-0.88 P \ 0.01) and three-dimension fluoroscopy-based navigation system (OR 95% CI, in vivo: 0.09-0.38; in vitro: 0.09-0.36 P \ 0.01) also obtained significant reduced screw deviation rate over traditional methods. Between navigated approaches, statistically insignificant individual and pooled RR values were observed for all in vivo subgroups. Pooled estimate of in vitro studies show that computer tomography-based and three-dimension fluoroscopy-based navigation system provided more accurate pedicle screw insertion over two-dimension fluoroscopy-based navigation system. Our review showed that navigation provided a higher accuracy in the placement of pedicle screws compared with conventional methods. The superiority of navigation systems was obvious when they were applied to abnormal spinal structure. Although no strong in vivo evidence has detected significantly different pedicle screw placement accuracy among the three major navigation systems, meta-analysis revealed the variance in pedicle screw insertion accuracy with different navigation methods.

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Section: Resultsmentioning

confidence: 99%

Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

et al. 2010

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“…At review, 48 papers were excluded as they did not meet the inclusion criteria (Table 1). Thus, 23 publications [5,6,8,9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] were analysed in this paper (Table 2; 2 randomised controlled trials, 12 case-control studies and 9 case series). Three studies were in German language and remaining 20 studies were in English.…”

Section: Resultsmentioning

confidence: 99%

“…The reported pedicle screw misplacement in historical spinal literature can be as high as [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39].8% [1][2][3], but only a small number leads to complications (neurological, vascular or visceral injuries). But these complications can be potentially life and limb threatening.…”

Section: Introductionmentioning

confidence: 99%

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

et al. 2010

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A number of studies have shown increased accuracy of pedicle screw placement in spine with the help of computer-assisted navigation. The literature is lacking in regard to functional benefit derived from this technique. The aim of this systematic review was to look at the functional outcomes following computer-assisted pedicle screw placement in spine. A 'Dialog Datastar' search was used using optimized search strategy covering the period from 1950 to July 2009; 23 papers were finally included which met our inclusion criteria. We report on a total of 1,288 patients with 5,992 pedicle screws. The comparison of neurological complications in two groups demonstrated an odds ratio of 0.25 (95% CI 0.06, 1.14) in favour of using navigation for pedicle screw insertion (p = 0.07). Comparative trials demonstrated a significant advantage in terms of accuracy of navigation over conventional pedicle screw insertion with a relative risk of 1.12 (95% CI 1.09, 1.15) (p \ 0.00001). Navigation does not show statistically significant benefit in reducing neurological complications and there was insufficient data in the literature to infer a conclusion in terms of fusion rate, pain relief and health outcome scores.

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“…Amiot et al [3] later performed this technique in vitro with a magnetic-field based navigator, however this never really gained clinical acceptance. Laine et al [15] presented evidence for improvement of accuracy under clinical conditions using this technique. In 1996, we started the laboratory testing the clinical application of computer-assisted spine surgery [11,12].…”

Section: Introductionmentioning

confidence: 99%

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

et al. 2006

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To reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions, the authors have been using C1/2 transarticular and cervical pedicle screw fixations. Pedicle screw fixation and C1/2 transarticular screw fixation are biomechanically superior to other fixation techniques for RA patients. However, due to severe spinal deformity and small anatomical size of the vertebra, including the lateral mass and pedicle, in the most RA cervical lesions, these screw fixation procedures are technically demanding and pose the potential risk of neurovascular injuries. The purpose of this study was to evaluate the accuracy and safety of cervical pedicle screw insertion to the deformed, fragile, and small RA spine lesions using computer-assisted image-guidance systems. A frameless, stereotactic image-guidance system that is CT-based, and optoelectronic was used for correct screw placement. A total of 21 patients (16 females, 5 males) with cervical disorders due to RA were surgically treated using the image-guidance system. Postoperative computerized tomography and plane X-ray was used to determine the accuracy of the screw placement. Neural and vascular complications associated with screw insertion and postoperative neural recovery were evaluated. Postoperative radiological evaluations revealed that only 1 (2.1%; C4) of 48 screws inserted into the cervical pedicle had perforated the vertebral artery canal more than 25% (critical breach). However, no neurovascular complications were observed. According to Ranawat's classification, 9 patients remained the same, and 12 patients showed improvement. Instrumentation failure, loss of reduction, or nonunion was not observed at the final followup (average 49.5 months; range 24-96 months). In this study, the authors demonstrated that image-guidance systems could be applied safely to the cervical lesions caused by RA. Image-guidance systems are useful tools in preoperative planning and in transarticular or transpedicular screw placement in the cervical spine of RA patients.

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Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients

Cited by 494 publications

References 14 publications

Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

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