Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis

Abstract

Study design: Systematic review and meta-analysis. Aim: The purpose of this study was to compare the safety and accuracy of the C2 pedicle versus C2 pars screws placement and free-hand technique versus navigation for upper cervical fusion patients. Methods: Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library to identify all papers published up to April 2020 that have evaluated C2 pedicle/pars screws placement accuracy. Two authors individually screened the literature according to the inclusion and exclusion criteria. The accuracy rates associated with C2 pedicle/pars were extracted. The pooled accuracy rate estimated was performed by the CMA software. A funnel plot based on accuracy rate estimate was used to evaluate publication bias. Results: From 1123 potentially relevant studies, 142 full-text publications were screened. We analyzed data from 79 studies involving 4431 patients with 6026 C2 pedicle or pars screw placement. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Overall, funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the accuracy rates were 93.8% for C2 pedicle screw free-hand, 93.7% for pars screw free-hand, 92.2% for navigated C2 pedicle screw, and 86.2% for navigated C2 pars screw (all, P value < 0.001). No statistically significant differences were observed between the accuracy of placement C2 pedicle versus C2 pars screws with the free-hand technique and the free-hand C2 pedicle group versus the navigated C2 pedicle group (all, P value > 0.05). Conclusion: Overall, there was no difference in the safety and accuracy between the free-hand and navigated techniques. Further well-conducted studies with detailed stratification are needed to complement our findings.

C2 Screw fixation techniques in atlantoaxial instability: A technical review

“…[ 41 ] Azimi et al . [ 42 ] discovered that the accuracy rate of C2 pars/pedicle screw placement for the freehand group was comparable to that of the navigation group. Furthermore, these techniques might increase the operative time and overall cost of surgery.…”

Biochemical and immunological blood parameters in patients with inflammatory complications after spine screw fixation

“…Упровадження нових розробок дозволило значно розширити можливості допомоги вертебрологічним хворим. Водночас, широке застосування транспедикулярної фіксації виявило певну кількість можливих ускладнень, одним із яких є навколоконструкційне запалення м'яких тканин [4]. У зв'язку з цим особливу актуальність набуває дослідження метаболічного статусу пацієнтів до початку хірургічного лікування для визначення ризику виникнення ускладнень [5].…”

Effect of High-Riding Vertebral Artery on the Accuracy and Safety of C2 Pedicle Screw Placement in Basilar Invagination and Related Risk Factors

“…HRVA is commonly associated with unusual tortuosity at the isthmus of C2 vertebra that courses more medially, posteriorly or superiorly than normal and alters the morphology and volume of the C2 pedicle, ultimately contributing to the narrowness of the trajectory for C2PS placement. 27 Therefore, pars or laminar screw fixation is usually chosen as the alternative method for placement on the side of the VA variant. 7,17 Given that medial tortuosity, rather than posterior and superior tortuosities, mainly increases the risk of VA injury and malpositioning, HRVA is not the absolute contraindication for pedicle screw placement.…”