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Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis

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Abstract

Purpose

Although pediatric spinal deformity correction using pedicle screws has a very low rate of complications, the long-term consequences of screw malposition is unknown. CT navigation has been proposed to improve screw accuracy. The aim of this study was to determine whether intraoperative navigation during pedicle screw placement in pediatric scoliosis makes screw placement more accurate. We also examined radiation exposure, operative time blood loss and complications with and without the use of CT navigation in pediatric spinal deformity surgery.

Methods

A systematic review of the literature was conducted. After screening, 13 articles were qualitatively and quantitatively analyzed to be used for the review. A random effects meta-analysis using REML methodology was employed to compare outcomes of screw accuracy, estimated blood loss, radiation exposure, and surgical duration.

Results

Screws placed with CT navigation surgery were three times as likely to be deemed “acceptable” compared with screws placed with freehand and 2D fluoroscopy assistance, twice as likely to be “perfect”, and only 1/3 as likely to be potentially unsafe (all p value < 0.01). EBL was not significantly different between groups; however, operative time was roughly thirty minutes longer on average. Random effects analysis showed no significant difference in effective dose radiation while using CT navigation (p = 0.06).

Conclusion

This systematic review of the literature demonstrates that intraoperative navigation results in more accurate pedicle screw placement compared to non-navigated techniques. We found that blood loss was similar in navigated and non-navigated surgery. Operative time was found to be approximately a half hour longer on average in navigated compared to non-navigated surgery. Effective radiation dose trended higher in navigated cases compared to non-navigated cases but did not reach statistical significance.

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Funding

No funds, grants, or other support was received.

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Author notes

  1. Keith D. Baldwin and Manasa Kadiyala are co-first authors.

Authors and Affiliations

  1. Division of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Keith D. Baldwin, Divya Talwar, Wudbhav N. Sankar, John (Jack) M. Flynn & Jason B. Anari

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Keith D. Baldwin & Manasa Kadiyala

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  1. Keith D. Baldwin
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Contributions

KDB, MK, DT, WNS, JMF, JBA: conception or design of work; Acquisition, analysis, or interpretation of data for the work; Drafting of work or revising it critically for important intellectual content; Final approval of version to be published.

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Correspondence to Keith D. Baldwin.

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Conflict of interest

KDB owns stock in Pfizer, Inc. JMF reports royalties or other material support from Wolters Kluwer Health and Biomet and serves as a board member of the American Board of Orthopaedic Surgery. All other authors have no relevant financial or non-financial interests to disclose.

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This study did not require IRB approval as no subject data was accessed.

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This study did not require informed consent as no subject data was accessed.

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Baldwin, K.D., Kadiyala, M., Talwar, D. et al. Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis. Spine Deform 10, 19–29 (2022). https://doi.org/10.1007/s43390-021-00385-5

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