Top

Published in:

01-07-2016 | Review

Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw placement: a meta-analysis

Authors: Xiao-tong Meng, Xiao-fei Guan, Hai-long Zhang, Shi-sheng He

Published in: Neurosurgical Review | Issue 3/2016

Abstract

Although application of intraoperative computer navigation technique had been integrated into placement of pedicle screws (PSs) in thoracic fusion for years, its security and practicability remain controversial. The aim of this study is to evaluate the accuracy, the operative time consumption, the amount of intraoperative blood loss, time of pedicle insertion and the incidence of complications of thoracic pedicle screw placement in patients with thoracic diseases such as scoliosis and kyphosis. Pubmed, Web of Knowledge, and Google scholar were searched to identify comparative studies of thoracic pedicle screw placement between intraoperative computer navigation and fluoroscopy-guided navigation. Outcomes of malposition rate, operative time consumption, insertion time, intraoperative blood loss, and the incidence of complications are evaluated. Fourteen articles including 1723 patients and 9019 PSs were identified matching inclusion criteria. The malposition rate was lower (RR: 0.33, 95 % CI: 0.28–0.38, P < 0.01) in computer navigation group than that in fluoroscopy-guided navigation group; the operative time was significantly longer [weighted mean difference (WMD) = 23.66, 95 % CI: 14.74–32.57, P < 0.01] in computer navigation group than that in fluoroscopy-guided navigation group. The time of insertion was shorter (WMD = −1.88, 95 % CI: −2.25– −1.52, P < 0.01) in computer navigation group than that in fluoroscopy-guided navigation group. The incidence of complications was lower (RR = 0. 23, 95 % CI: 0.12–0.46, P < 0.01) in computer navigation group than that in the other group. The intraoperative blood loss was fewer (WMD = −167.49, 95 % CI: −266.39– −68.58, P < 0.01) in computer navigation group than that in the other. In conclusion, the meta-analysis of thoracic pedicle screw placement studies clearly demonstrated lower malposition rate, less intraoperative blood loss, and fewer complications when using computer navigation. This result provides strong evidence that computer technology could be safer and more reliable than fluoroscopy-guided navigation.

Abe Y et al (2011) A novel cost-effective computer-assisted imaging technology for accurate placement of thoracic PSs. J Neurosurg Spine 15(5):479–485CrossRefPubMed

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

Allam Y et al (2013) Computer tomography assessment of pedicle screw placement in thoracic spine: comparison between free hand and a generic 3D-based navigation techniques. Eur Spine J

Esses SI, Sachs BL, Dreyzin V (1993) Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members. Spine 18:2231–2238CrossRefPubMed

Fu TS, Wong CB, Tsai TT et al (2007) Pedicle screw insertion: computed tomography versus fluoroscopic image guidance. Int Orthop

Gelalis ID, Paschos NK, Pakos EE et al (2012) Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J 21:247–255CrossRefPubMed

Haberland N, Ebmeier K, Hliscs R et al (1999) Intraoperative CT in image-guided surgery of the spine. Medicamundi 43:24–31

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

Hicks JM, Singla A, Shen FH et al (2010) Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976) 35(11):E465–E470CrossRef

10.

Houten JK, Nasser R, Baxi N (2012) Clinical assessment of percutaneous lumbar pedicle screw placement using the O-arm multidimensional surgical imaging system. Neurosurgery 70(4):990–995CrossRefPubMed

11.

Huang Y et al (2009) Application of C-arm X-ray navigation and CT navigation in thoracolumbar pedicle screw fixation, a contrast observation. Shangdong Med 14:5–7

12.

Katonis P, Christoforakis J, Aligizakis AC et al (2003) Complications and problems related to pedicle screw fixation of the spine. Clin Orthop 411:86–94CrossRefPubMed

13.

Kosmopoulos V, Schizas C (2007) Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976) 32:E111–E120CrossRef

14.

Laine T et al (2000) Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J 9(3):235–240CrossRefPubMedPubMedCentral

15.

Laine T, Schlenzka D, Mäkitalo K et al (1997) Improved accuracy of pedicle screw insertion with computer-assisted surgery. Spine 22:1254–1258CrossRefPubMed

16.

Lekovic GP, Potts EA, Karahalios DG et al (2007) A comparison of two techniques in image-guided thoracic pedicle screw placement: a retrospective study of 37 patients and 277 PSs. J Neurosurg Spine 7(4):393–398CrossRefPubMed

17.

Li Q, Tian Q, Liu B et al (2007) Percutaneous pedicle screw fixation in thoracic-lumbar fracture using mini-invasive pedicle screw system guided by navigation. China Med Mag 87(19):1339–1341

18.

Lonstein JE, Denis F, Perra JH et al (1999) Complications associated with PSs. J Bone Joint Surg Am 81- A:1519–1528

19.

Luther, N et al (2013) Comparison of navigated versus non-navigated pedicle screw placement in 260 patients and 1434 screws: screw accuracy, screw size, and the complexity of surgery. J Spinal Disord Tech

20.

Makino K, Fujiwara H et al Morphometric analysis using multiple anarreconstructed CT of the lumbar pedicle in patients with degenerative lumbar scoliosis is characterized by a Cobb angle of 30 degrees or greater. J Neurosurg Spine 17(3):256–262. 102

21.

Merloz P et al (1998) Computer-assisted surgery: automated screw placement in the vertebral pedicle. Chirurgie 123(5):482–490CrossRefPubMed

22.

Merloz P, Troccaz J, Vouaillat H et al (2007) Fluoroscopy-based navigation system in spine surgery. Proc Inst Mech Eng [H] 221(7):813–820CrossRef

23.

Panjabi MM, Takata K, Goel V et al (1991) Thoracic human vertebrae. Quantitative three-dimensional anatomy. Spine 16:888–901CrossRefPubMed

24.

Rajasekaran S et al (2007) Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic PSs in deformity correction surgeries. Spine (Phila Pa 1976) 32(2):E56–E64CrossRef

25.

Ringel F, Stoffel M, Stuer C et al (2006) Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine. Neurosurgery 59(4 Suppl 2):ONS361-6, discussion ONS366-7

26.

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

27.

Sasso RC, Garrido BJ (2007) Computer-assisted spinal navigation versus serial radiography and operative time for posterior spinal fusion at L5-S1. J Spinal Disord Tech 20(2):118–122CrossRefPubMed

28.

Seller K et al (2005) Prospective screw misplacement analysis after fluoroscopy-guided and navigated pedicle screw implantation. Biomed Technol (Berl) 50(9):287–292CrossRef

29.

Shin MH et al (2012) Accuracy and safety in pedicle screw placement in the thoracic and lumbar spines: comparison study between fluoroscopy-guided C-Arm fluoroscopy and navigation coupled with O-Arm(R) guided methods. J Korean Neurosurg Soc 52(3):204–209CrossRefPubMedPubMedCentral

30.

Steinmann JC, Herkowitz HN, ei-Kommons H et al (1993) Spinal pedicle fixation: confirmation of an image-based technique for screw placement[J]. Spine 18(13):1856–1861CrossRefPubMed

31.

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

32.

Tian NF, Huang QS, Zhou P, Zhou Y, Wu RK, Lou Y et al (2011) Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur Spine J 20:846–859CrossRefPubMed

33.

Tian NF, Xu HZ (2009) Image-guided pedicle screw insertion accuracy: a meta-analysis. Int Orthop 33:895–903CrossRefPubMedPubMedCentral

34.

Tormenti MJ et al (2010) Intraoperative computed tomography image-guided navigation for posterior thoracolumbar spinal instrumentation in spinal deformity surgery. Neurosurg Focus 28(3):E11CrossRefPubMed

35.

Torres J et al (2012) Screw placement accuracy for minimally invasive transforaminal lumbar interbody fusion surgery: a study on 3-D neuronavigation-guided surgery. Global Spine J 2(3):143CrossRefPubMedPubMedCentral

36.

Vaccaro AR, Rizzolo SJ, Allardyce TJ, Ramsey M, Salvo J, Balderston RA, Cotler JM (1995) Placement of PSs in the thoracic spine. Part I: morphometric analysis of the thoracic vertebrae. J Bone Joint Surg Am 77:1193–1199PubMed

37.

Verma R, Krishan S, Haendlmayer K, Mohsen A (2010) Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws. Eur Spine J 19:370–375CrossRefPubMedPubMedCentral

38.

Waschke A et al (2013) CT-navigation versus fluoroscopy-guided placement of PSs at the thoracolumbar spine: single center experience of 4,500 screws. Eur Spine J 22(3):654–660CrossRefPubMed

39.

Wu H et al (2010) Pedicle screw placement in the thoracic spine: a randomized comparison study of computer-assisted navigation and fluoroscopy-guided techniques. Chin J Traumatol Chin Med Assoc 13(4):201–205

40.

Zausinger S, Scheder B, Uhl E et al (2009) Intraoperative computed tomography with integrated navigation system in spinal stabilizations. Spine (Phila Pa1976) 34(26):2919–2926CrossRef

41.

Zhang B, et al (2006) The application of 3D navigation-assisted thoracic-lumbar PSs placement in interbody fusion. Anhui Med Univ

42.

Zong Z (2009) A comparative study of application between three-dimensional navigation assisted and X-ray fluoroscopy in thoracolumbar pedicle screw fixation. Beijing Univ Chin Med

Title: Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw placement: a meta-analysis
Authors: Xiao-tong Meng
Xiao-fei Guan
Hai-long Zhang
Shi-sheng He
Publication date: 01-07-2016
Publisher: Springer Berlin Heidelberg
Published in: Neurosurgical Review / Issue 3/2016
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-015-0679-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw placement: a meta-analysis

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2016

Editorial

Identification of specific age groups with a high risk for developing cerebral vasospasm after aneurysmal subarachnoid hemorrhage

Surgical management of symptomatic brain stem cavernoma in a developing country: technical difficulties and outcome

Laser biospectroscopy and 5-ALA fluorescence navigation as a helpful tool in the meningioma resection

The outcome of a surgical protocol based on ischemia overprotection in large and giant aneurysms of the anterior cerebral circulation

A minimum 2-year comparative study of autologous cancellous bone grafting versus beta-tricalcium phosphate in anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage