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Abstract
BACKGROUND: Pedicle screws (PS) are routinely used for stabilization to enhance fusion in a variety of spinal pathologies. Although the accuracy of different PS placement methods has been previously reported, the majority of these studies have been limited to one or two techniques.OBJECTIVE: To determine the current accuracy of PS placement among four modalities of PS insertion [free-hand (FH), fluoroscopy-assisted (FA), CT-navigation guided (CTNav), and robot-assisted (RA)] and analyze variables associated with screw misplacement.METHODS: A systematic review of peer-reviewed articles reporting PS accuracy of one technique from January 1990 to June 2018 was performed. 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: 78 studies with 7,858 patients, 51,161 PSs, and 3,614 cortical PBs were included. CTNav displayed the highest PS placement accuracy compared to 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 to FH.CONCLUSIONS: The OP data show that CTNav has the highest PS accuracy rates. Thoracic PSs were associated with lower accuracy rates; however, RA exhibited fewer breaches in the thoracic spine compared to FH and FA. Given the heterogeneity among studies, further standardized and comparative investigations are required to confirm our findings.
View details for PubMedID 30880208