Liu Po-Chun, Lu Yi, Lin Hsi-Hsien, Yao Yu-Cheng, Chang Ming-Chau, Wang Shih-Tien, Chou Po-Hsin
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2023 Jan 1;86(1):113-121. doi: 10.1097/JCMA.0000000000000788. Epub 2022 Jul 29.
Superior facet joint violation (FJV) is a potential risk factor for adjacent segment disease following lumbar fusion surgery. We sought to conduct a systematic review and meta-analysis to compare screw-related superior FJV rates between the open and different minimally invasive (MI) techniques-fluoroscopy-based, 3D-image navigation, and navigation with robotic assistance-in adult lumbar fusion surgery.
We searched original articles comparing the rates of screw-related FJV between the open and different MI techniques in adult lumbar fusion surgery for lumbar degenerative diseases in PubMed, EMBASE, and the Cochrane Library from inception to September 2021. We compared the numbers of top-level pedicle screws and associated superior FJVs in the main analyses and performed subgroup analysis based on different MI techniques to examine whether individual MI approaches differed in superior FJV rate. Risk ratio (RR) and 95% confidence interval (CI) were calculated in a random-effect meta-analysis.
Included in the meta-analysis were 16 articles with 2655 patients and 4638 top-level pedicle screws. The pooled analysis showed no significant difference in superior FJV rates between the MI and open groups (RR: 0.89, 95% CI: 0.62-1.28). The subgroup analysis demonstrated that the overall rates of superior FJV were 27.1% (411/1518) for fluoroscopy-based, 7.1% (43/603) for 3D-image navigation, and 3.2% (7/216) for navigation with robotic assistance. Compared with the open method, the overall RRs were 1.53 (95% CI: 1.19-1.96) for fluoroscopy-based, 0.41 (95% CI: 0.22-0.75) for 3D-image navigation, and 0.25 (95% CI: 0.08-0.72) for navigation with robotic assistance.
Among the three common MI techniques, fluoroscopy-based can be associated with a higher risk of superior FJV, while both 3D-image navigation and navigation with robotic assistance may be associated with lower risks as compared with the open method. Considering the limitations of the study, more trials are needed to prove these clinical findings.
上关节突关节损伤（FJV）是腰椎融合手术后相邻节段疾病的一个潜在风险因素。我们旨在进行一项系统评价和荟萃分析，以比较成人腰椎融合手术中开放手术与不同的微创（MI）技术（基于荧光透视、三维图像导航和机器人辅助导航）之间与螺钉相关的上关节突关节损伤率。
我们在PubMed、EMBASE和Cochrane图书馆中检索了从数据库建立至2021年9月期间比较成人腰椎退变性疾病融合手术中开放手术与不同MI技术之间螺钉相关FJV率的原始文章。我们在主要分析中比较了顶级椎弓根螺钉数量和相关的上关节突关节损伤情况，并根据不同的MI技术进行亚组分析，以检查各MI方法在上关节突关节损伤率方面是否存在差异。在随机效应荟萃分析中计算风险比（RR）和95%置信区间（CI）。
纳入荟萃分析的有16篇文章，共2655例患者和4638枚顶级椎弓根螺钉。汇总分析显示，MI组和开放手术组在上关节突关节损伤率方面无显著差异（RR：0.89，95%CI：0.62-1.28）。亚组分析表明，基于荧光透视的上关节突关节损伤总体发生率为27.1%（411/1518），三维图像导航为7.1%（43/603），机器人辅助导航为3.2%（7/216）。与开放手术方法相比，基于荧光透视的总体RR为1.53（95%CI：1.19-1.96），三维图像导航为0.41（95%CI：0.22-0.75），机器人辅助导航为0.25（95%CI：0.08-0.72）。
在三种常见的MI技术中，基于荧光透视的技术可能与较高的上关节突关节损伤风险相关，而与开放手术方法相比，三维图像导航和机器人辅助导航两者可能与较低风险相关。考虑到本研究的局限性，需要更多试验来证实这些临床发现。
