Thoracic pedicle screw fixation using computer-guided vs. fluoroscopy-guided navigation

Study Type: Meta analysis
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
14 studies with a total of 1723 patients were included in this meta-analysis to evaluate the clinical efficacy of thoracic pedicle screw placement between intraoperative computer navigation and fluoroscopy-guided navigation in thoracic spine surgery. Pooled outcomes included the malposition rate, operative time, complication rate, pedicle insertion time, and intraoperative blood loss. Findings indicated significant Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
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Why was this study needed now?
Pedicle screw and rod constructs are often used in procedures addressing thoracic spine conditions, such as scoliosis, kyphosis, or vertebral fracture. Although generally a successful technique, technical difficulty may be slightly higher compared to other areas due to the smaller pedicle size within the thoracic spine. Computer navigation has been used for some time now in orthopaedics, with utility extending to instrumented procedures of the thoracic spine. However, the use of a computer navigation is not without potential drawbacks, such as increased operative time and adjacent neurologic or vascular complications if misplaced. Accordingly, the safety and efficacy of computer-guided navigation compared to traditional fluoroscopy-guided procedures was still unclear.
What was the principal research question?
In instrumented thoracic spine procedures, how did computer navigation and fluoroscopy-guided navigation compare in terms of accuracy of screw placement, operative time, intraoperative blood loss, time of pedicle insertion, and complication rate?
Data Source: Pubmed, Web of Knowledge, and Google scholar databases were used to search for relevant studies.
Index Terms: Search terms consisted of the following: thoracic, pedicle screws placement, intraoperative computer navigation, and fluoroscopy-guided navigation.
Study Selection: Eligibility criteria included: randomized controlled trial (RCTs) design; enrolled patients with thoracic disease and undergoing instrumented surgery with posterior pedicle screw fixation; and reported the incidence of pedicle screw malposition. Study selection was performed independently by two reviewers. A total of 14 RCTs, with data sampled from 1723 patients, were selected for final inclusion.
Data Extraction: Data extraction methods were not reported in this study. Outcomes included malposition rate, incidence of complications, time of insertion, operative consumption, and intraoperative blood loss.
Data Synthesis: Data synthesis was performed with the Review Manager (RevMan 5.2) software. Dichotomous outcomes were reported with risk ratios (RR) and 95% confidence intervals (CIs). The random effects model was used when heterogeneity was significant (I^2>50%) and the fixed effects model was used when heterogeneity was not significant (I^2<50%). Sensitivity analysis was performed in analyses with high heterogeneity.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.