Meta-analysis on application of computer-assisted navigation in lumbar pedicle screw fixation

doi:10.3969/j.issn.2095-4344.2014.09.016

Abstract

Abstract:

BACKGROUND: Computer-assisted navigation technique has been widely applied in spinal surgery, but there is still lack of systematic reviews on this technique in lumbar pedicle screw fixation.
OBJECTIVE: To evaluate the application of computer-assisted navigation technique in lumbar pedicle screw fixation.
METHODS: Databases such as PubMed, Embase and China journal full-text database CNKI were searched for articles about computer-assisted navigation in lumbar pedicle screw fixation, and related studies and literatures were hand-searched as well, and then insertion accuracy, intraoperative blood loss, operative time consumption and rate of insertion-related complications between computer-assisted navigation technique group and conservative technique group were compared.
RESULTS AND CONCLUSION: Finally 7 studies which met the inclusion criteria were included with 784 patients and 4 101 lumbar pedicle screws in total. Meta-analysis indicated that malposition rate [relative risk (RR)=0.44, 95% confidence interval (CI): (0.27, 0.69), P=0.000 4] and intraoperative blood loss [weighted mean difference (WMD)=-172.40, 95%CI: (-246.26, -98.53), P < 0.000 01] had statistically significant differences between computer-assisted navigation technique group and conservative insertion group. However, operative time consumption [WMD=-31.45, 95%CI: (-85.56, 22.66), P=0.25] and incidence of complications [RR=0.41, 95%CI: (0.12, 1.41), P=0.16] did not show significant differences between groups. Application of computer-assisted navigation technique in lumbar pedicle screw fixation would improve insertion accuracy. However, further study is still needed to make clear whether this technique can improve final outcome in post-operative patients.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: lumbar vertebrae, internal fixators, computer systems, spine, meta-analysis

CLC Number:

R318

Wang Peng, Jin Ge-le, Yang Yi. Meta-analysis on application of computer-assisted navigation in lumbar pedicle screw fixation[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(9): 1404-1409.

Figures/Tables 6

References

[1]Tsahtsarlis A, Efendy JL, Mannion RJ, et al. Complications from minimally invasive lumbar interbody fusion: experience from 100 patients. J Clin Neurosci. 2013;20(6):813-817.

[2]Barsa P, Suchomel P. Portable CT scanner-based navigation in lumbar pedicle screw insertion. Eur Spine J. 2013;22(6): 1446-1450.

[3]Van de Kelft E, Costa F, Van der Planken D, et al. A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation. Spine (Phila Pa 1976). 2012;37(25):1580-1587.

[4]田伟,刘亚军,刘波,等. 计算机导航在脊柱外科手术应用实验和临床研究[J].中华骨科杂志,2006,26(10):671-675.

[5]McCormick F, Cvetanovich GL, Kim JM, et al. An assessment of the quality of rotator cuff randomized controlled trials: utilizing the Jadad score and CONSORT criteria. J Shoulder Elbow Surg. 2013;22(9):1180-1185.

[6]Tow BP, Yue WM, Srivastava A, et al. Does Navigation Improve Accuracy of Placement of Pedicle Screws in Single Level Lumbar Degenerative Spondylolisthesis? - A Comparison Between Free-hand and 3D O-Arm Navigation Techniques. J Spinal Disord Tech. 2013 Oct 30.

[7]Yang BP, Wahl MM, Idler CS. Percutaneous lumbar pedicle screw placement aided by computer-assisted fluoroscopy- based navigation: perioperative results of a prospective, comparative, multicenter study. Spine (Phila Pa 1976). 2012;37(24):2055-2060.

[8]Shin MH, Ryu KS, Park CK. Accuracy and Safety in Pedicle Screw Placement in the Thoracic and Lumbar Spines : Comparison Study between Conventional C-Arm Fluoroscopy and Navigation Coupled with O-Arm(R) Guided Methods. J Korean Neurosurg Soc. 2012;52(3):204-209.

[9]Silbermann J, Riese F, Allam Y, et al. Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between free-hand and O-arm based navigation techniques. Eur Spine J. 2011;20(6):875-881.

[10]Fraser J, Gebhard H, Irie D, et al. Iso-C/3-dimensional neuronavigation versus conventional fluoroscopy for minimally invasive pedicle screw placement in lumbar fusion. Minim Invasive Neurosurg. 2010;53(4):184-190.

[11]俞兴,徐林,毕连涌,等. 术中三维导航引导的腰椎弓根螺钉植入效果分析[J]. 中华医学杂志,2008,88(27):1905-1908.

[12]Laine T, Lund T, Ylikoski M, et al. Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J. 2000;9(3):235-240.

[13]Richter M, Mattes T, Cakir B. Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J. 2004;13(1):50-59.

[14]Xu R, Ebraheim NA, Ou Y, et al. Anatomic considerations of pedicle screw placement in the thoracic spine. Roy-Camille technique versus open-lamina technique. Spine (Phila Pa 1976). 1998;23(9):1065-1068.

[15]Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976). 1990;15(1):11-14.

[16]Manbachi A, Cobbold RS, Ginsberg HJ. Guided pedicle screw insertion: techniques and training. Spine J. 2013 Apr 25.

[17]Iampreechakul P, Chongchokdee C, Tirakotai W. The accuracy of computer-assisted pedicle screw placement in degenerative lumbrosacral spine using single-time, paired point registration alone technique combined with the surgeon's experience. J Med Assoc Thai. 2011;94(3):337- 345.

[18]Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976). 2007; 32(3):111-120.

[19]Su BW, Kim PD, Cha TD, et al. An anatomical study of the mid-lateral pars relative to the pedicle footprint in the lower lumbar spine. Spine (Phila Pa 1976). 2009;34(13):1355-1362.

[20]Makino T, Kaito T, Fujiwara H, et al. Morphometric analysis using multiplanar reconstructed CT of the lumbar pedicle in patients with degenerative lumbar scoliosis characterized by a Cobb angle of 30 degrees or greater. J Neurosurg Spine. 2012;17(3):256-262.

[21]Sahoo MM, Mahapatra SK, Sethi GC, et al. Posterior-only approach surgery for fixation and decompression of thoracolumbar spinal tuberculosis: a retrospective study. J Spinal Disord Tech. 2012;25(7):217-223.

[22]Steinmann JC, Herkowitz HN, el-Kommos H, et al. Spinal pedicle fixation. Confirmation of an image-based technique for screw placement. Spine (Phila Pa 1976). 1993;18(13): 1856-1861.

[23]Houten JK, Nasser R, Baxi N. Clinical assessment of percutaneous lumbar pedicle screw placement using theO-arm multidimensional surgical imaging system. Neurosurgery. 2012;70(4):990-995.

[24]Ailawadhi P, Agrawal D, Satyarthee GD, et al. Use of O-arm for spinal surgery in academic institution in India: experience from JPN apex trauma centre. Neurol India. 2011;59(4): 590- 593.

[25]Zausinger S, Scheder B, Uhl E, et al. Intraoperative computed tomography with integrated navigation system in spinal stabilizations. Spine (Phila Pa 1976). 2009;34(26):2919-2926.

[26]Hartl R, Lam KS, Wang J, et al. Worldwide survey on the use of navigation in spine surgery. World Neurosurg. 2013;79(1): 162-172.

[27]Rimawi M, Hilsenbeck SG. Making sense of clinical trial data: is inverse probability of censoring weighted analysis the answer to crossover bias? J Clin Oncol. 2012;30(4):453-458.