The comparative accuracy and safety of fluoroscopic and navigation-based techniques in cervical pedicle screw fixation: systematic review and meta-analysis

2021 ◽  
pp. 1-8
Author(s):  
Ahmad M. Tarawneh ◽  
Shahnawaz Haleem ◽  
Daniel D’Aquino ◽  
Nasir Quraishi
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Meta Analysis ◽  
Pedicle Screw Fixation ◽  
Cochrane Library ◽  
Complication Rates ◽  
Ct Guided ◽  
Cervical Pedicle Screw ◽  
Comparative Accuracy ◽  
Cervical Pedicle

OBJECTIVE The goal of this study was to evaluate the comparative accuracy and safety of navigation-based approaches for cervical pedicle screw (CPS) placement over fluoroscopic techniques. METHODS A systematic search of the literature published between January 2006 and December 2019 relating to CPS instrumentation and the comparative accuracy and safety of fluoroscopic and intraoperative computer-based navigation techniques was conducted. Several databases, including the Cochrane Library, PubMed, and EMBASE, were systematically searched to identify potentially eligible studies. Data relating to CPS insertion accuracy and associated complications, in particular neurovascular complications, were extrapolated from the included studies and summarized for analysis. RESULTS A total of 17 studies were identified from the search methodology. Eleven studies evaluated CPS placement under traditional fluoroscopic guidance and 6 studies addressed outcomes following navigation-assisted placement (3D C-arm or CT-guided placement). Overall, a total of 4278 screws were placed in 1065 patients. Misplacement rates of CPS were significantly lower (p < 0.0001) in navigation-assisted techniques (12.51% [range 2.5%–20.5%]) compared to fluoroscopy-guided techniques (18.8% [range 0%–43.5%]). Fluoroscopy-guided CPS insertion was associated with a significantly higher incidence of postoperative complications relating to neurovascular injuries (p < 0.038), with a mean incidence of 1.9% compared with 0.3% in navigation-assisted techniques. CONCLUSIONS This systematic review supports a logical conclusion that navigation-based techniques confer a statistically significantly more accurate screw placement and resultant lower complication rates.

scholarly journals Cervical Spine Pedicle Screw Accuracy in Fluoroscopic, Navigated and Template Guided Systems—A Systematic Review

Tomography ◽  
2021 ◽  
Vol 7 (4) ◽  
pp. 614-622
Author(s):  
Arin Mahmoud ◽  
Kanatheepan Shanmuganathan ◽  
Brett Rocos ◽  
Fady Sedra ◽  
Alexander Montgomery ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Spine ◽  
Radiation Exposure ◽  
Pedicle Screw ◽  
Cochrane Library ◽  
Computer Assisted ◽  
Invasive Approach ◽  
Cervical Pedicle Screw ◽  
Wide Range ◽  
Cervical Pedicle

Background: Pedicle screws provide excellent fixation for a wide range of indications. However, their adoption in the cervical spine has been slower than in the thoracic and lumbar spine, which is largely due to the smaller pedicle sizes and the proximity to the neurovascular structures in the neck. In recent years, technology has been developed to improve the accuracy and thereby the safety of cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer-assisted Systems and 3D template moulds. We have performed a systematic review into the accuracy rates of the various systems. Methods: The PubMed and Cochrane Library databases were searched for eligible papers; 9 valid papers involving 1427 screws were found. Results: fluoroscopic methods achieved an 80.6% accuracy and navigation methods produced 91.4% and 96.7% accuracy for templates. Conclusion: Navigation methods are significantly more accurate than fluoroscopy, they reduce radiation exposure to the surgical team, and improvements in technology are speeding up operating times. Significantly superior results for templates over fluoroscopy and navigation are complemented by reduced radiation exposure to patient and surgeon; however, the technology requires a more invasive approach, prolonged pre-operative planning and the development of an infrastructure to allow for their rapid production and delivery. We affirm the superiority of navigation over other methods for providing the most accurate and the safest cervical pedicle screw instrumentation, as it is more accurate than fluoroscopy and lacks the limitations of templates.

scholarly journals Cervical pedicle screw fixation in traumatic cervical subluxation after laminectomy using the pedicle axis view technique under fluoroscopy

2012 ◽  
Vol 2012 (oct09 1) ◽  
pp. bcr-2012-006545-bcr-2012-006545 ◽  
Author(s):  
M. Machino ◽  
Y. Yukawa ◽  
K. Ito ◽  
H. Nakashima ◽  
S. Kanbara ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Cervical Pedicle Screw ◽  
Cervical Pedicle ◽  
Cervical Subluxation ◽  
Axis View

scholarly journals Percutaneous, Navigated Minimally Invasive Posterior Cervical Pedicle Screw Fixation

10.14444/7122 ◽  
2020 ◽  
Vol 14 (s3) ◽  
pp. S14-S21
Author(s):  
Domagoj Coric ◽  
Vincent J. Rossi ◽  
John Peloza ◽  
Paul K. Kim ◽  
Tim E. Adamson
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Cervical Pedicle Screw ◽  
Cervical Pedicle

scholarly journals Image-Guided Cervical Pedicle Screw Fixation: Implant Precision and Complications in 67 Consecutive Patients

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554333-s-0035-1554333
Author(s):  
John Michael Duff ◽  
Yves Henchoz ◽  
Marc Levivier ◽  
Lukas Bobinski
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Cervical Pedicle Screw ◽  
Image Guided ◽  
Cervical Pedicle

scholarly journals A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis

2018 ◽  
Vol 44 (1) ◽  
pp. E10 ◽  
Author(s):  
Nasser Mohammed ◽  
Devi Prasad Patra ◽  
Vinayak Narayan ◽  
Amey R. Savardekar ◽  
Rimal Hanif Dossani ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Low Grade ◽  
Complication Rates ◽  
Operative Techniques ◽  
Advantages And Disadvantages ◽  
Direct Repair ◽  
Pars Interarticularis ◽  
Repair Group

OBJECTIVESpondylosis with or without spondylolisthesis that does not respond to conservative management has an excellent outcome with direct pars interarticularis repair. Direct repair preserves the segmental spinal motion. A number of operative techniques for direct repair are practiced; however, the procedure of choice is not clearly defined. The present study aims to clarify the advantages and disadvantages of the different operative techniques and their outcomes.METHODSA meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following databases were searched: PubMed, Cochrane Library, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature). Studies of patients with spondylolysis with or without low-grade spondylolisthesis who underwent direct repair were included. The patients were divided into 4 groups based on the operative technique used: the Buck repair group, Scott repair group, Morscher repair group, and pedicle screw–based repair group. The pooled data were analyzed using the DerSimonian and Laird random-effects model. Tests for bias and heterogeneity were performed. The I2 statistic was calculated, and the results were analyzed. Statistical analysis was performed using StatsDirect version 2.RESULTSForty-six studies consisting of 900 patients were included in the study. The majority of the patients were in their 2nd decade of life. The Buck group included 19 studies with 305 patients; the Scott group had 8 studies with 162 patients. The Morscher method included 5 studies with 193 patients, and the pedicle group included 14 studies with 240 patients. The overall pooled fusion, complication, and outcome rates were calculated. The pooled rates for fusion for the Buck, Scott, Morscher, and pedicle screw groups were 83.53%, 81.57%, 77.72%, and 90.21%, respectively. The pooled complication rates for the Buck, Scott, Morscher, and pedicle screw groups were 13.41%, 22.35%, 27.42%, and 12.8%, respectively, and the pooled positive outcome rates for the Buck, Scott, Morscher, and pedicle screw groups were 84.33%, 82.49%, 80.30%, and 80.1%, respectively. The pedicle group had the best fusion rate and lowest complication rate.CONCLUSIONSThe pedicle screw–based direct pars repair for spondylolysis and low-grade spondylolisthesis is the best choice of procedure, with the highest fusion and lowest complication rates, followed by the Buck repair. The Morscher and Scott repairs were associated with a high rate of complication and lower rates of fusion.

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