In this paper the authors' goal was to compare the accuracy of computer-navigated pedicle screw insertion with nonnavigated techniques in the published literature.
The authors performed a systematic literature review using the National Center for Biotechnology Information Database (PubMed/MEDLINE) using the Medical Subject Headings (MeSH) terms “Neuronavigation,” “Therapy, computer assisted,” and “Stereotaxic techniques,” and the text word “pedicle.” Included in the meta-analysis were randomized control trials or patient cohort series, all of which compared computer-navigated spine surgery (CNSS) and nonassisted pedicle screw insertions. The primary end point was pedicle perforation, while the secondary end points were operative time, blood loss, and complications.
Twenty studies were included for analysis; of which there were 18 cohort studies and 2 randomized controlled trials published between 2000 and 2011. Foreign-language papers were translated. The total number of screws included was 8539 (4814 navigated and 3725 nonnavigated). The most common indications for surgery were degenerative disease, spinal deformity, myelopathy, tumor, and trauma. Navigational methods were primarily based on CT imaging. All regions of the spine were represented. The relative risk for pedicle screw perforation was determined to be 0.39 (p < 0.001), favoring navigation. The overall pedicle screw perforation risk for navigation was 6%, while the overall pedicle screw perforation risk was 15% for conventional insertion. No related neurological complications were reported with navigated insertion (4814 screws total); there were 3 neurological complications in the nonnavigated group (3725 screws total). Furthermore, the meta-analysis did not reveal a significant difference in total operative time and estimated blood loss when comparing the 2 modalities.
There is a significantly lower risk of pedicle perforation for navigated screw insertion compared with nonnavigated insertion for all spinal regions.
Abbreviations used in this paper:CAS = computer-assisted surgery; CNSS = computer-navigated spine surgery; EBL = estimated blood loss; MeSH = Medical Subject Headings; MIS = minimally invasive surgery; RCT = randomized controlled trial.
Address correspondence to: Roger Härtl, M.D., Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, Box 99, New York, New York 10065. email: firstname.lastname@example.org.
Please include this information when citing this paper: published online June 22, 2012; DOI: 10.3171/2012.5.SPINE11399.
AmiotLPLangKPutzierMZippelHLabelleH: Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine (Phila Pa 1976)25:606–6142000
GröbeAWeberCSchmelzleRHeilandMKlattJPohlenzP: The use of navigation (BrainLAB Vector vision(2)) and intraoperative 3D imaging system (Siemens Arcadis Orbic 3D) in the treatment of gunshot wounds of the maxillofacial region. Oral Maxillofac Surg13:153–1582009
HanWGaoZLWangJCLiYPPengXRuiJ: Pedicle screw placement in the thoracic spine: a comparison study of computer-assisted navigation and conventional techniques. Orthopedics33:DOI: 10.3928/01477447-20100625-142010
HärtlRLhamKWangJKorgeAKandzioraF: The AOSpine ANEG (Access and Navigation Expert Group) survey on the use of navigation in spine surgery. Presented at the Global Spine Congress 2011Barcelona, SpainMarch 23–262011. (Abstract) (http://www.neuro.opole.pl/gsc.pdf
KotaniYAbumiKItoMTakahataMSudoHOhshimaS: Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique. Spine (Phila Pa 1976)32:1543–15502007
LaineTLundTYlikoskiMLohikoskiJSchlenzkaD: Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J9:235–2402000
LeeGYMassicotteEMRampersaudYR: Clinical accuracy of cervicothoracic pedicle screw placement: a comparison of the “open” lamino-foraminotomy and computer-assisted techniques. J Spinal Disord Tech20:25–322007
LiuYJTianWLiuBLiQHuLLiZY: [Accuracy of CT-based navigation of pedicle screws implantation in the cervical spine compared with X-ray fluoroscopy technique.]. Zhonghua Wai Ke Za Zhi43:1328–13302005. (Chinese)
RajasekaranSVidyadharaSRameshPShettyAP: Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976)32:E56–E642007
SilbermannJRieseFAllamYReichertTKoeppertHGutberletM: Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between freehand and O-arm based navigation techniques. Eur Spine J20:875–8812011
WiesnerLKotheRSchulitzKPRütherW: Clinical evaluation and computed tomography scan analysis of screw tracts after percutaneous insertion of pedicle screws in the lumbar spine. Spine (Phila Pa 1976)25:615–6212000