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Image-guided pedicle screw insertion accuracy: a meta-analysis

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Abstract

Improved pedicle screw insertion accuracy has been reported with the assistance of computer tomography-based navigation. Studies also indicated that fluoroscopy-based navigation offers high accuracy and is comparable to CT-based assistance. However, different population characteristics and assessment methods resulted in inconsistent conclusions. We searched OVID, Springer, and MEDLINE databases to conduct a meta-analysis of the published literature specifically looking at accuracy of pedicle screw placement with different navigation methods. Subgroups and descriptive statistics were determined based on the subject type (in vivo or cadaveric), navigational method, and spinal level. A total number of 7,533 pedicle screws were summarised in our database with 6,721 screws accurately inserted into the pedicles (89.22%). Overall, the median placement accuracy for the in vivo CT-based navigation subgroup (90.76%) was higher than that with the use of two-dimensional (2D) fluoroscopy-based navigation (85.48%). We concluded that CT-based navigation could provide a higher accuracy in the placement of pedicle screws for all subgroups presented. In the lumbar level, 2D fluoroscopy-based navigation was comparable with CT-based navigation. Discrepancy between the two navigation types increased in the thoracic level for the in vivo populations, where there was less potential in the use of 2D fluoroscopy-based navigation than CT-based navigation.

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References

  1. Harrington PR, Tullos HS (1969) Reduction of severe spondylolisthesis in children. South Med J 62:1–7

    PubMed  CAS  Google Scholar 

  2. Suk SI, Lee CK, Min HJ, Cho KH, Oh JH (1994) Comparison of Cotrel-Dubousset pedicle screws and hooks in the treatment of idiopathic scoliosis. Int Orthop 18:341–346

    Article  PubMed  CAS  Google Scholar 

  3. Karatoprak O, Unay K, Tezer M, Ozturk C, Aydogan M, Mirzanli C (2008) Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery. Int Orthop 32:523–528

    Article  PubMed  Google Scholar 

  4. Luring C, Oczipka F, Grifka J, Perlick L (2008) The computer-assisted sequential lateral soft-tissue release in total knee arthroplasty for valgus knees. Int Orthop 32:229–235

    Article  PubMed  CAS  Google Scholar 

  5. Ybinger T, Kumpan W (2007) Enhanced acetabular component positioning through computer-assisted navigation. Int Orthop 31:S35–S38

    Article  PubMed  Google Scholar 

  6. Seon JK, Song EK, Yoon TR, Bae BH, Park SJ, Cho SG (2007) In vivo stability of total knee arthroplasty using a navigation system. Int Orthop 31:45–48

    Article  PubMed  Google Scholar 

  7. Lekovic GP, Potts EA, Karahalios DG, Hall G (2007) A comparison of two techniques in image-guided thoracic pedicle screw placement: a retrospective study of 37 patients and 277 pedicle screws. J Neurosurg Spine 7:393–398

    Article  PubMed  Google Scholar 

  8. Kotani Y, Abumi K, Ito M, Takahata M, Sudo H, Ohshima S, Minami A (2007) Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique. Spine 32:1543–1550

    Article  PubMed  Google Scholar 

  9. Lim MR, Girardi FP, Yoon SC, Huang RC, Cammisa FP (2005) Accuracy of computerized frameless stereotactic image-guided pedicle screw placement into previously fused lumbar spines. Spine 30:1793–1898

    Article  PubMed  Google Scholar 

  10. Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D (2000) Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J 9:235–240

    Article  PubMed  CAS  Google Scholar 

  11. Papadopoulos EC, Girardi FP, Sama A, Sandhu HS, Cammisa FP Jr (2005) Accuracy of single-time, multilevel registration in image-guided spinal surgery. Spine J 5:263–267

    Article  PubMed  Google Scholar 

  12. Richter M, Cakir B, Schmidt R (2005) Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws. Spine 30:2280–2287

    Article  PubMed  Google Scholar 

  13. Lee GY, Massicotte EM, Rampersaud YR (2007) Clinical accuracy of cervicothoracic pedicle screw placement: a comparison of the "open" lamino-foraminotomy and computer-assisted techniques. J Spinal Disord Tech 20:25–32

    Article  PubMed  Google Scholar 

  14. Rampersaud YR, Pik JH, Salonen D, Farooq S (2005) Clinical accuracy of fluoroscopic computer-assisted pedicle screw fixation: a CT analysis. Spine 30:E183–E190

    Article  PubMed  Google Scholar 

  15. Amiot LP, Lang K, Putzier M, Zippel H, Labelle H (2000) Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine 25:606–614

    Article  PubMed  CAS  Google Scholar 

  16. Fu TS, Chen LH, Wong CB, Lai PL, Tsai TT, Niu CC, Chen WJ (2004) Computer-assisted fluoroscopic navigation of pedicle screw insertion: an in vivo feasibility study. Acta Orthop Scand 75:730–735

    Article  PubMed  Google Scholar 

  17. Richter M, Mattes T, Cakir B (2004) Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J 13:50–59

    Article  PubMed  Google Scholar 

  18. Ito H, Neo M, Yoshida M, Fujibayashi S, Yoshitomi H, Nakamura T (2007) Efficacy of computer-assisted pedicle screw insertion for cervical instability in RA patients. Rheumatol Int 27:567–574

    Article  PubMed  CAS  Google Scholar 

  19. Rampersaud YR, Lee KS (2007) Fluoroscopic computer-assisted pedicle screw placement through a mature fusion mass: an assessment of 24 consecutive cases with independent analysis of computed tomography and clinical data. Spine 32:217–222

    Article  PubMed  Google Scholar 

  20. Carbone JJ, Tortolani PJ, Quartararo LG (2003) Fluoroscopically assisted pedicle screw fixation for thoracic and thoracolumbar injuries: technique and short-term complications. Spine 28:91–97

    Article  PubMed  Google Scholar 

  21. Merloz P, Troccaz J, Vouaillat H, Vasile C, Tonetti J, Eid A, Plaweski S (2007) Fluoroscopy-based navigation system in spine surgery. Proc Inst Mech Eng [H] 221:813–820

    CAS  Google Scholar 

  22. Laine T, Schlenzka D, Mäkitalo K, Tallroth K, Nolte LP, Visarius H (1997) Improved accuracy of pedicle screw insertion with computer-assisted surgery. A prospective clinical trial of 30 patients. Spine 22:1254–1258

    Article  PubMed  CAS  Google Scholar 

  23. Fu TS, Wong CB, Tsai TT, Liang YC, Chen LH, Chen WJ (2008) Pedicle screw insertion: computed tomography versus fluoroscopic image guidance. Int Orthop 32:517–521

    Article  PubMed  Google Scholar 

  24. Merloz P, Tonetti J, Pittet L, Coulomb M, Lavalleé S, Sautot P (1998) Pedicle screw placement using image guided techniques. Clin Orthop Relat Res 354:39–48

    Article  PubMed  Google Scholar 

  25. Rajasekaran S, Vidyadhara S, Ramesh P, Shetty AP (2007) Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine 32:E56–E64

    Article  PubMed  CAS  Google Scholar 

  26. Seichi A, Takeshita K, Nakajima S, Akune T, Kawaguchi H, Nakamura K (2005) Revision cervical spine surgery using transarticular or pedicle screws under a computer-assisted image-guidance system. J Orthop Sci 10:385–390

    Article  PubMed  Google Scholar 

  27. Sakai Y, Matsuyama Y, Nakamura H, Katayama Y, Imagama S, Ito Z, Ishiguro N (2008) Segmental pedicle screwing for idiopathic scoliosis using computer-assisted surgery. J Spinal Disord Tech 21:181–186

    Article  PubMed  Google Scholar 

  28. Lee TC, Yang LC, Liliang PC, Su TM, Rau CS, Chen HJ (2004) Single versus separate registration for computer-assisted lumbar pedicle screw placement. Spine 29:1585–1589

    Article  PubMed  Google Scholar 

  29. Arand M, Hartwig E, Kinzl L, Gebhard F (2002) Spinal navigation in tumor surgery of the thoracic spine: first clinical results. Clin Orthop Relat Res 399:211–218

    Article  PubMed  Google Scholar 

  30. Youkilis AS, Quint DJ, McGillicuddy JE, Papadopoulos SM (2001) Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery 48:771–778

    Article  PubMed  CAS  Google Scholar 

  31. Nakanishi K, Tanaka M, Misawa H, Sugimoto Y, Takigawa T, Ozaki T (2009) Usefulness of a navigation system in surgery for scoliosis: segmental pedicle screw fixation in the treatment. Arch Orthop Trauma Surg. Published Online January 29, 2009

  32. Liu YJ, Tian W, Liu B, Li Q, Hu L, Li ZY, Yuan Q, Xing YG, Wang YQ, Sun YZ (2005) Accuracy of CT-based navigation of pedicle screws implantation in the cervical spine compared with X-ray fluoroscopy technique. Chin J Surg 43:1328–1330

    PubMed  Google Scholar 

  33. Arand M, Hartwig E, Hebold D, Kinzl L, Gebhard F (2001) Precision analysis of navigation-assisted implanted thoracic and lumbar pedicled screws. A prospective clinical study. Unfallchirurg 104:1076–1081

    Article  PubMed  CAS  Google Scholar 

  34. Wendl K, von Recum J, Wentzensen A, Grützner PA (2003) Iso-C(3D0-assisted) navigated implantation of pedicle screws in thoracic lumbar vertebrae. Unfallchirurg 106:907–913

    PubMed  CAS  Google Scholar 

  35. Seller K, Wild A, Urselmann L, Krauspe R (2005) Prospective screw misplacement analysis after conventional and navigated pedicle screw implantation. Biomed Tech (Berl) 50:287–292

    Article  CAS  Google Scholar 

  36. Schnake KJ, König B, Berth U, Schroeder RJ, Kandziora F, Stöckle U, Raschke M, Haas NP (2004) Accuracy of CT-based navigation of pedicle screws in the thoracic spine compared with conventional technique. Unfallchirurg 107:104–112

    Article  PubMed  CAS  Google Scholar 

  37. Schwarzenbach O, Berlemann U, Jost B, Visarius H, Arm E, Langlotz F, Nolte LP, Ozdoba C (1997) Accuracy of computer-assisted pedicle screw placement. An in vivo computed tomography analysis. Spine 22:452–458

    Article  PubMed  CAS  Google Scholar 

  38. Nottmeier EW, Seemer W, Young PM (2009) Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine 10:33–39

    Article  PubMed  Google Scholar 

  39. Ito Y, Sugimoto Y, Tomioka M, Hasegawa Y, Nakago K, Yagata Y (2008) Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion. J Neurosurg Spine 9:450–453

    Article  PubMed  Google Scholar 

  40. Rath SA, Moszko S, Schäffner PM, Cantone G, Braun V, Richter HP, Antoniadis G (2008) Accuracy of pedicle screw insertion in the cervical spine for internal fixation using frameless stereotactic guidance. J Neurosurg Spine 8:237–245

    Article  PubMed  Google Scholar 

  41. Nolte LP, Slomczykowski MA, Berlemann U, Strauss MJ, Hofstetter R, Schlenzka D, Laine T, Lund T (2000) A new approach to computer-aided spine surgery: fluoroscopy-based surgical navigation. Eur Spine J 9:S78–S88

    Article  PubMed  Google Scholar 

  42. John PS, James C, Antony J, Tessamma T, Ananda R, Dinesh K (2007) A novel computer-assisted technique for pedicle screw insertion. Int J Med Robot 3:59–63

    PubMed  CAS  Google Scholar 

  43. Mirza SK, Wiggins GC, Kuntz C 4th, York JE, Bellabarba C, Knonodi MA, Chapman JR, Shaffrey CI (2003) Accuracy of thoracic vertebral body screw placement using standard fluoroscopy, fluoroscopic image guidance, and computed tomographic image guidance: a cadaver study. Spine 28:402–413

    Article  PubMed  Google Scholar 

  44. Ludwig SC, Kowalski JM, Edwards CC 2nd, Heller JG (2000) Cervical pedicle screws: comparative accuracy of two insertion techniques. Spine 25:2675–2681

    Article  PubMed  CAS  Google Scholar 

  45. Choi WW, Green BA, Levi AD (2000) Computer-assisted fluoroscopic targeting system for pedicle screw insertion. Neurosurgery 47:872–878

    Article  PubMed  CAS  Google Scholar 

  46. Richter M, Amiot LP, Neller S, Kluger P, Puhl W (2000) Computer-assisted surgery in posterior instrumentation of the cervical spine: an in-vitro feasibility study. Eur Spine J 9:S65–S70

    Article  PubMed  Google Scholar 

  47. Kim KD, Patrick Johnson J, Bloch BSO, Masciopinto JE (2001) Computer-assisted thoracic pedicle screw placement: an in vitro feasibility study. Spine 26:360–364

    Article  PubMed  CAS  Google Scholar 

  48. Sagi HC, Manos R, Park SC, Von Jako R, Ordway NR, Connolly PJ (2003) Electromagnetic field-based image-guided spine surgery part two: results of a cadaveric study evaluating thoracic pedicle screw placement. Spine 28:E351–E354

    Article  PubMed  CAS  Google Scholar 

  49. Sagi HC, Manos R, Benz R, Ordway NR, Connolly PJ (2003) Electromagnetic field-based image-guided spine surgery part one: results of a cadaveric study evaluating lumbar pedicle screw placement. Spine 28:2013–2018

    Article  PubMed  CAS  Google Scholar 

  50. Austin MS, Vaccaro AR, Brislin B, Nachwalter R, Hilibrand AS, Albert TJ (2002) Image-guided spine surgery: a cadaver study comparing conventional open laminoforaminotomy and two image-guided techniques for pedicle screw placement in posterolateral fusion and nonfusion models. Spine 27:2503–2508

    Article  PubMed  Google Scholar 

  51. Hart RA, Hansen BL, Shea M, Hsu F, Anderson GJ (2005) Pedicle screw placement in the thoracic spine: a comparison of image-guided and manual techniques in cadavers. Spine 30:E326–E331

    Article  PubMed  Google Scholar 

  52. Holly LT, Foley KT (2006) Percutaneous placement of posterior cervical screws using three-dimensional fluoroscopy. Spine 31:536–540

    Article  PubMed  Google Scholar 

  53. Ludwig SC, Kramer DL, Balderston RA, Vaccaro AR, Foley KF, Albert TJ (2000) Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine 25:1655–1667

    Article  PubMed  CAS  Google Scholar 

  54. Schwend RM, Dewire PJ, Kowalski TM (2000) Accuracy of fluoroscopically assisted laser targeting of the cadaveric thoracic and lumbar spine to place transpedicular screws. J Spinal Disord 13:412–418

    Article  PubMed  CAS  Google Scholar 

  55. Assaker R, Reyns N, Vinchon M, Demondion X, Louis E (2001) Transpedicular screw placement: image-guided versus lateral-view fluoroscopy: in vitro simulation. Spine 26:2160–2164

    Article  PubMed  CAS  Google Scholar 

  56. Amiot LP, Bellefleur C, Labelle H (1997) In vitro evaluation of computer-assisted pedicle screw system. Ann Chir 51:854–860

    PubMed  CAS  Google Scholar 

  57. Foley KT, Sahjpaul RL, Rodts GR (2000) Virtual fluoroscopy improves lumbar pedicle screw placement accuracy. Neurosurgery 47:530

    Article  Google Scholar 

  58. Carl AL Khanuja, Sachs HS, Gatto BL, John CA, Kirby V, John V, William S (1997) In vitro simulation: early results of stereotaxy for pedicle screw placement. Spine 22:1160–1164

    Article  PubMed  CAS  Google Scholar 

  59. Foley KT, Smith MM, Abitbol JJ (1996) Thoracic pedicle screw placement accuracy: image-interactive guidance versus conventional techniques paper. Neurosurgery 39:653

    Article  Google Scholar 

  60. Reinhold M, Bach C, Audigé L, Bale R, Attal R, Blauth M, Magerl F (2008) Comparison of two novel fluoroscopy-based stereotactic methods for cervical pedicle screw placement and review of the literature. Eur Spine J 17:564–575

    Article  PubMed  CAS  Google Scholar 

  61. Kosmopoulos V, Schizas C (2007) Pedicle screw placement accuracy: a meta-analysis. Spine 32:E111–E120

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Zhejiang Spine Research Center, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, Wenzhou, 325000, China

    Nai-Feng Tian & Hua-Zi Xu

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  1. Nai-Feng Tian
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  2. Hua-Zi Xu
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Correspondence to Hua-Zi Xu.

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Tian, NF., Xu, HZ. Image-guided pedicle screw insertion accuracy: a meta-analysis. International Orthopaedics (SICOT) 33, 895–903 (2009). https://doi.org/10.1007/s00264-009-0792-3

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