Trends in Technology for Pedicle Screw Placement

Abstract

Study Design. Systematic Review Objective. We sought to determine which method of the pedicle screw (PS) placement is most accurate and understand how the development of subsequent generations of robotic systems has changed placement accuracy over time. Summary of Background Data. Previous studies have demonstrated the success of robotic PS placement, but how this accuracy compares to other methods is unclear. Methods. A systematic review following PRISMA Guidelines was performed on articles published between January 2000 and August 2021, comparing PS insertion methods with at least 10 screws per study arm. Single and multiple-arm trials were included. Data were extracted for patient outcomes, including optimal PS placement, misplacement, and accuracy. The logit-event rate of misplacement was calculated for each study. P values were adjusted for multiple comparisons using the Tukey post hoc correction. Results. Our search revealed 127 studies, and 156 comparative arms, with 77,360 pedicle screws placed using five different modalities. Meta-regression of pooled accuracy revealed no significant changes in PS accuracy over time for freehand, 2D fluoroscopic navigation, 3D fluoroscopic navigation, and computed tomography navigation. Robotic navigation had a significant increase in accuracy over time (P = 0.036). Pooled misplacement rates were also compared across all modalities. Robotics was found to have the lowest rates of misplacement for PS compared to freehand (P = 0.0015) and 2D fluoroscopic navigation (P = 0.026). Conclusion. Our analysis is the largest study to date on pedicle screw placement. Pedicle screw placement through robotics was found to be superior due to its low misplacement rates compared with other modalities. Intraoperative 3D fluoroscopic navigation was found to have comparable misplacement rates. In addition, pedicle screw placement accuracy with robotics has continued to improve over time. This speaks to both the stability of the technology and the potential for continued improvement with new and more accurate robotic systems.

The Subjective and Objective Improvement Using Chiropractic Biophysics® Protocols

“…Many of these show unusual cases that are unique and offer insight into possible treatments for distinct conditions. Pedicle screw fixation has been in use for 80 years and although is it successful often, failure rates are found to be 34% to 64% [28,29]. This failure can be due to failure of single or multiple screws and/or rods, loosening of the hardware, poor placement, poor purchase of bone, or simply due to poor post-surgical improvement in sagittal and coronal balance with related adjacent segmental degeneration, osteoporosis, and other arthritic and degenerative pathologies [1,[4][5][6][7]29].…”

“…If the HRQoL and the sagittal and coronal balance are not improved and/or there is hardware failure, infection, or vascular abnormalities due to the surgery, a diagnosis of FBSS/PSPS is requisite [30]. Poor low back spine surgical outcomes are treated with many conservative drug therapies including nonsteroidal anti-inflammatories and over-the-counter pain relievers as well as prescription opioids and steroids, and physical therapies [2,3,5,[27][28][29].…”

Letter to the Editor. Validity of the results of network meta-analysis

“…However, NMA of non-RCTs has been performed. [3][4][5] Even noncomparative studies, like case series, have been included in methodologies of NMA to bolster the analytical power of studies with limited sample sizes. 6,7 Our analysis was designed to present the best possible analysis given the current state of data.…”

Spinal Robotics in Adult Spinal Deformity Surgery: A Systematic Review

“…Spinal robotic systems, such as the Mazor X Stealth (Medtronic, Minneapolis, MN, USA) and ExcelsiusGPS (Globus Medical, Audubon, PA, USA), and their associated planning software have the potential to successfully address these issues [ 5 ]. Robot-assisted pedicle screw placement has consistently shown to be comparable if not more accurate than placement with freehand techniques [ 6 , 7 ]. However, limited studies have compared the efficacy of robotically placed S2 alar-iliac (S2AI) screws in ASD surgery to freehand techniques [ 8 ].…”