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

Abstract

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.

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

“…In conclusion, both in vivo and in vitro subgroups revealed that navigation method obtained a significant lesser pooled risk of pedicle violation compared with the conventional method (P \ 0.05). The results were consistent with those of Kosmopoulos and Schizas, Verma et al [8,56] (Fig. 1).…”

“…Navigation provided a higher accuracy in the placement of pedicle screws for most of the subgroups presented. In a pooled analysis of 14 comparative studies on pedicle screw insertion, Verma et al [56] also demonstrated a significant advantage in terms of accuracy of navigation over conventional methods. The limitation was that the two reviews analyzed different navigation methods together, and drew pooled navigated pedicle screw insertion accuracy.…”

“…A meta-analysis on functional outcome also indicated that navigation did not significantly reduce neurological complications and sufficient data were not available to draw a conclusion on other functional outcomes [56].…”

Accuracy of lower cervical pedicle screw placement with assistance of distinct navigation systems: a human cadaveric study

“…The computer-assisted navigation system has been gradually applied into spine surgeries [7]. However, the natural value of the navigation system in the spinal surgical procedure was questioned [8]. Recent studies suggested that the accuracy of the pedicle screw placement in the lower thoracic and lumbar spine could be improved with a navigation system [9][10][11].…”

Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review

“…The accuracy of pedicle screw implantation using these techniques varies considerably in the literature (from 28 to 94 %), though the evidence generally favors the use of image-guidance systems [5,10,25,27]. A miniature spine-mounted robot has recently been developed to further improve the accuracy of pedicle screw placement [2,4,22].…”