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Comparison of major spine navigation platforms based on key performance metrics: a meta-analysis of 16,040 screws

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Abstract

Purpose

The objective of this meta-analysis is to compare available computer-assisted navigation platforms by key performance metrics including pedicle screw placement accuracy, operative time, neurological complications, and blood loss.

Methods

A systematic review was conducted using major databases for articles comparing pedicle screw accuracy of computer-assisted navigation to conventional (freehand or fluoroscopy) controls via post-operative computed tomography. Outcome data were extracted and pooled by random-effects model for analysis.

Results

All navigation platforms demonstrated significant reduction in risk of breach, with Stryker demonstrating the highest accuracy compared to controls (OR 0.16 95% CI 0.06 to 0.41, P < 0.00001, I2 = 0%) followed by Medtronic. There were no significant differences in accuracy or most surgical outcome measures between platforms; however, BrainLab demonstrated significantly faster operative time compared to Medtronic by 30 min (95% CI − 63.27 to − 2.47, P = 0.03, I2 = 74%). Together, there was significantly lower risk of major breach in the navigation group compared to controls (OR 0.42, 95% CI 0.27–0.63, P < 0.0001, I2 = 56%).

Conclusions

When comparing between platforms, Stryker demonstrated the highest accuracy, and Brainlab the shortest operative time, both followed by Medtronic. No significant difference was found between platforms regarding neurologic complications or blood loss. Overall, our results demonstrated a 60% reduction in risk of major breach utilizing computer-assisted navigation, coinciding with previous studies, and supporting its validity. This study is the first to directly compare available navigation platforms offering insight for further investigation and aiding in the institutional procurement of platforms.

Level 3 evidence

Meta-analysis of Level 3 studies.

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Data sharing statement

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON, M5S 1A8, Canada

    John-Peter Bonello, Robert Koucheki & Aazad Abbas

  2. Institute of Biomedical Engineering, University of Toronto, Toronto, Canada

    Robert Koucheki & Johnathan Lex

  3. Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada

    Johnathan Lex, Albert Yee, Henry Ahn, Joel Finkelstein, Stephen Lewis, Jeremie Larouche & Jay Toor

  4. Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada

    Nicholas Nucci

  5. Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada

    Albert Yee, Joel Finkelstein & Jeremie Larouche

  6. Division of Orthopaedic Surgery, St. Michael’s Hospital, Toronto, Canada

    Henry Ahn

  7. Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Canada

    Stephen Lewis

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Bonello, JP., Koucheki, R., Abbas, A. et al. Comparison of major spine navigation platforms based on key performance metrics: a meta-analysis of 16,040 screws. Eur Spine J 32, 2937–2948 (2023). https://doi.org/10.1007/s00586-023-07865-4

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