Taylor Charles, Lam Chuck, Manoj Nikhil, Divekar Omkaar
Department of Education, St George's University of London, London, UK.
Department of Acute Medicine, St George's Hospital, NHS Foundation Trust, London, UK.
Spine Surg Relat Res. 2024 Dec 10;9(3):269-282. doi: 10.22603/ssrr.2024-0223. eCollection 2025 May 27.
Spinal fusion is a common form of orthopedic surgery, the most common of which involves pedicle screw placement (PSP). Despite well-documented benefits, pedicle screws are associated with several intraoperative complications. This area of surgery has subsequently been recipient to many surgical developments. Currently, augmented reality surgical navigation (ARSN) is at the forefront of surgical interest. This systematic review evaluates whether, when compared to freehand, fluoroscopic, and intraoperative image-guided navigation, ARSN results in superior screw accuracy and operative outcomes for patients undergoing PSP surgery.
Data collection was performed on PubMed, Ovid MEDLINE, the Cochrane Library, Embase, and the Web of Science between January 7, 2023, and January 8, 2024. PRISMA guidelines were followed and the level of evidence was graded per the Centre for Evidence-Based Medicine's recommendations. Risk of bias was assessed per the ROBINS-I tool and the Cochrane guide for assessing study quality. A modified version of the Newcastle-Ottawa Scale was used to determine the certainty of the body of evidence.
A total of 521 papers were obtained from all bibliographical databases, 31 of which were included in the final review. ARSN resulted in a significantly greater number of screws placed as Gertzbein and Robbins grade 1 or 2 (93.33% vs 85.86%, p<0.000), significantly reduced intraoperative blood loss (470.32 vs 802.44 ml, p=0.050), comparative operative duration (281.6 vs 255.5 min, p=0.819), comparative time to place a screw (2.71 vs 3.1 min, p=0.703), and a nonsignificant reduction in hospital stay (5.4 vs 7.5 days, p=0.097). Maximum follow-up was more than 14 days.
ARSN results in a significantly greater number of screws placed at Gertzbein-Robertson grade 1 or 2 than non-ARSN surgery. Therefore, ARSN can be considered as a safe and efficacious technical innovation within PSP surgery.
脊柱融合术是一种常见的骨科手术形式，其中最常见的涉及椎弓根螺钉置入（PSP）。尽管有充分记录的益处，但椎弓根螺钉与多种术中并发症相关。该手术领域随后经历了许多手术技术的发展。目前，增强现实手术导航（ARSN）处于手术研究的前沿。本系统评价评估与徒手、透视和术中影像引导导航相比，ARSN对于接受PSP手术的患者是否能带来更高的螺钉置入准确性和更好的手术效果。
于2023年1月7日至2024年1月8日在PubMed、Ovid MEDLINE、Cochrane图书馆、Embase和科学网进行数据收集。遵循PRISMA指南，并根据循证医学中心的建议对证据水平进行分级。使用ROBINS - I工具和Cochrane评估研究质量指南评估偏倚风险。采用改良版的纽卡斯尔 - 渥太华量表来确定证据体的确定性。
从所有文献数据库共获得521篇论文，其中31篇纳入最终评价。ARSN置入的Gertzbein和Robbins 1级或2级螺钉数量显著更多（93.33%对85.86%，p<0.000），术中失血量显著减少（470.32对802.44毫升，p = 0.050），手术时长相当（281.6对255.5分钟，p = 0.819），置钉时间相当（2.71对3.1分钟，p = 0.703），住院时间有非显著缩短（5.4对7.5天，p = 0.097）。最长随访时间超过14天。
与非ARSN手术相比，ARSN置入的Gertzbein - Robertson 1级或2级螺钉数量显著更多。因此，ARSN可被视为PSP手术中一种安全有效的技术创新。
