Improved Accuracy of Pedicle Screw Insertion With Computer-Assisted Surgery

Laine, Timo; Schlenzka, Dietrich; Mäkitalo, Kirsti; Tallroth, Kaj; Nolte, L.-P.; Visarius, Heiko

doi:10.1097/00007632-199706010-00018

Cited by 283 publications

(156 citation statements)

References 11 publications

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“…Of these, 46 were excluded because they were case series. The remaining 43 papers [11-51, 54, 55] [18,23,37], 4 prospective comparative studies [22,25,27,29] and 21 retrospective comparative studies [12-17, 19-21, 24, 26, 28, 30-36, 38, 55].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2010

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Studies revealed that navigation systems that provided intraoperative assistance might improve pedicle screw insertion accuracy, and also implied that different systems provided different pedicle screw insertion accuracy. A systematic review and meta-analysis was conducted to focus on the pedicle screw insertion accuracy with or without the assistance of image-guided system, and the variance among the different navigation systems. Comparative studies were searched on pedicle screw insertion accuracy between conventional and navigated method, and among different navigation systems. A total of 43 papers, including 28 clinical, 14 cadaveric and 1 model studies, were included in the current study. For clinical articles, there were 3 randomized clinical trials, 4 prospective comparative studies and 21 retrospective comparative studies. The incidence of pedicle violation among computer tomography-based navigation method group was statistically significantly less than that observed among the conventional group (OR 95% CI, in vivo: 0.32-0.60; in vitro: 0.24-0.75 P \ 0.01). Two-dimensional fluoroscopybased navigation system (OR 95% CI, in vivo: 0.27-0.48; in vitro: 0.43-0.88 P \ 0.01) and three-dimension fluoroscopy-based navigation system (OR 95% CI, in vivo: 0.09-0.38; in vitro: 0.09-0.36 P \ 0.01) also obtained significant reduced screw deviation rate over traditional methods. Between navigated approaches, statistically insignificant individual and pooled RR values were observed for all in vivo subgroups. Pooled estimate of in vitro studies show that computer tomography-based and three-dimension fluoroscopy-based navigation system provided more accurate pedicle screw insertion over two-dimension fluoroscopy-based navigation system. Our review showed that navigation provided a higher accuracy in the placement of pedicle screws compared with conventional methods. The superiority of navigation systems was obvious when they were applied to abnormal spinal structure. Although no strong in vivo evidence has detected significantly different pedicle screw placement accuracy among the three major navigation systems, meta-analysis revealed the variance in pedicle screw insertion accuracy with different navigation methods.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2010

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“…At review, 48 papers were excluded as they did not meet the inclusion criteria (Table 1). Thus, 23 publications [5,6,8,9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] were analysed in this paper (Table 2; 2 randomised controlled trials, 12 case-control studies and 9 case series). Three studies were in German language and remaining 20 studies were in English.…”

Section: Resultsmentioning

confidence: 99%

“…Computer-assisted navigation allows for simultaneous and multi-planar visualization of spinal anatomy which helps in virtually tracking surgical instruments in relation to displayed anatomy in real time [4]. This has led to its utilisation in pedicle screw placement thus increasing the accuracy of screw positioning in cadavers and patients [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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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.

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“…As in existing CT-based spinal navigation systems [8,18,25,26,33], cross-referencing including the image intensifier was introduced. In this way, the use of the new computer-based system with only one registered image is equivalent to the standard use of an image intensifier in constant mode.…”

Section: Discussionmentioning

confidence: 99%

“…These techniques require preoperative acquisition of a CT data set, providing for the first time a direct link between the preoperative plan and its intraoperative surgical execution. As a result, significantly improved misplacement rates have been reported in the literature [1,8,18,22,33]. Despite these convincing early results, there has been lack of widespread enthusiasm for CT-based spinal navigation systems.…”

mentioning

confidence: 99%

A new approach to computer-aided spine surgery: fluoroscopy-based surgical navigation

et al. 2000

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Improved Accuracy of Pedicle Screw Insertion With Computer-Assisted Surgery

Abstract: The accuracy of pedicle screw placement using computer-assisted surgery proved to be superior to the accuracy obtained when using conventional techniques.

Cited by 283 publications

References 11 publications

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

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

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

A new approach to computer-aided spine surgery: fluoroscopy-based surgical navigation

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