Bindels B J J, Dronkers B E G, Smits M L J, Verlaan J J
Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Global Spine J. 2024 Apr;14(3):1018-1037. doi: 10.1177/21925682231196456. Epub 2023 Aug 19.
Systematic review and meta-analysis.
To evaluate the accuracy of placement for cervical pedicle screws with and without the use of spinal navigation.
A structured search was conducted in electronic databases without any language or date restrictions. Eligible studies reported the proportion of accurately placed cervical pedicle screws measured on intraoperative or postoperative 3D imaging, and reported whether intraoperative navigation was used during screw placement. Randomized Studies (MINORS) criteria were used to evaluate the methodological quality of how accuracy was assessed for cervical pedicle screws.
After screening and critical appraisal, 4697 cervical pedicle screws from 18 studies were included in the meta-analysis. The pooled proportion for cervical pedicle screws with a breach up to 2 mm was 94% for navigated screws and did not differ from the pooled proportion for non-navigated screws (96%). The pooled proportion for cervical pedicle screws placed completely in the pedicle was 76% for navigated screws and did not differ from the pooled proportion for non-navigated screws (82%). Intraoperative screw reposition rates and screw revision rates as a result of postoperative imaging also did not differ between navigated and non-navigated screw placement.
This systematic review and meta-analysis found that the use of spinal navigation systems does not significantly improve the accuracy of placement of cervical pedicle screws compared to screws placed without navigation. Future studies evaluating intraoperative navigation for cervical pedicle screw placement should focus on the learning curve, postoperative complications, and the complexity of surgical cases.
系统评价与荟萃分析。
评估使用和不使用脊柱导航系统时颈椎椎弓根螺钉置入的准确性。
在电子数据库中进行结构化检索，无语言或日期限制。符合条件的研究报告了在术中或术后三维成像上测量的颈椎椎弓根螺钉准确置入的比例，并报告了螺钉置入过程中是否使用了术中导航。采用随机研究（MINORS）标准评估颈椎椎弓根螺钉准确性评估方法的质量。
经过筛选和严格评价，18项研究中的4697枚颈椎椎弓根螺钉纳入荟萃分析。导航螺钉椎弓根破裂达2毫米的合并比例为94%，与非导航螺钉的合并比例（96%）无差异。导航螺钉完全置入椎弓根的合并比例为76%，与非导航螺钉的合并比例（82%）无差异。术中螺钉重新定位率和术后成像导致的螺钉翻修率在导航螺钉和非导航螺钉置入之间也无差异。
本系统评价和荟萃分析发现，与未使用导航系统置入的螺钉相比，使用脊柱导航系统并未显著提高颈椎椎弓根螺钉置入的准确性。未来评估颈椎椎弓根螺钉置入术中导航的研究应关注学习曲线、术后并发症和手术病例的复杂性。
