Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Florida A&M University-Florida State University College of Engineering, Tallahassee, Florida, USA.
World Neurosurg. 2019 Jun;126:664-678.e3. doi: 10.1016/j.wneu.2019.02.217. Epub 2019 Mar 15.
Pedicle screws (PSs) are routinely used for stabilization to enhance fusion in a variety of spinal diseases. Although the accuracy of different PS placement methods has been previously reported, most of these studies have been limited to 1 or 2 techniques. The purpose was to determine the current accuracy of PS placement among 4 modalities of PS insertion (freehand [FH], fluoroscopy-assisted [FA], computed tomography navigation-guided [CTNav], and robot-assisted [RA]) and analyze variables associated with screw misplacement.
A systematic review was performed of peer-reviewed articles reporting PS accuracy of 1 technique from January 1990 to June 2018. Accuracy of PS placement, PS insertion technique, and pedicle breach (PB) data were collected. A meta-analysis was performed to estimate the overall pooled (OP) rates of PS accuracy as a primary outcome, stratified by screw insertion techniques. Potential determinants were analyzed via meta-regression analyses.
Seventy-eight studies with 7858 patients, 51,161 PSs, and 3614 cortical PBs were included. CTNav showed the highest PS placement accuracy compared with other techniques: OP accuracy rates were 95.5%, 93.1%, 91.5%, and 90.5%, via CTNav, FH, FA, and RA techniques, respectively. RA and CTNav were associated with the highest PS accuracy in the thoracic spine, compared with FH.
The OP data show that CTNav has the highest PS accuracy rates. Thoracic PSs were associated with lower accuracy rates; however, RA showed fewer breaches in the thoracic spine compared with FH and FA. Given the heterogeneity among studies, further standardized and comparative investigations are required to confirm our findings.
椎弓根螺钉（PS）通常用于稳定脊柱，以增强多种脊柱疾病的融合。尽管以前已经报道了不同 PS 放置方法的准确性，但这些研究大多仅限于 1 或 2 种技术。目的是确定 4 种 PS 插入方式（徒手[FH]、透视辅助[FA]、计算机断层导航引导[CTNav]和机器人辅助[RA]）中 PS 放置的当前准确性，并分析与螺钉错位相关的变量。
对 1990 年 1 月至 2018 年 6 月期间发表的关于 PS 准确性的同行评审文章进行了系统回顾。收集了 PS 放置准确性、PS 插入技术和椎弓根破裂（PB）数据。进行了荟萃分析，以估计 PS 放置准确性的总体汇总（OP）率作为主要结果，按螺钉插入技术分层。通过荟萃回归分析分析潜在的决定因素。
纳入了 78 项研究，共 7858 例患者，51161 枚 PS 和 3614 枚皮质 PB。与其他技术相比，CTNav 显示 PS 放置准确性最高：OP 准确性分别为 95.5%、93.1%、91.5%和 90.5%，通过 CTNav、FH、FA 和 RA 技术。与 FH 相比，RA 和 CTNav 与胸椎 PS 具有最高的 PS 准确性。
OP 数据显示 CTNav 具有最高的 PS 准确性。胸椎 PS 与较低的准确性率相关，但与 FH 和 FA 相比，RA 在胸椎中出现的破裂较少。鉴于研究之间存在异质性，需要进一步进行标准化和比较性研究以证实我们的发现。
