Pedicle screw placement accuracy: a meta-analysis.
METHODS
A meta-analysis of the published literature was conducted specifically looking at accuracy and the postoperative methods used for the assessment of pedicle screw placement in the human spine.


OBJECTIVE
This study specifically aimed to identify postoperative methods used for pedicle screw placement assessment, including the most common method, and to report cumulative pedicle screw placement study statistics from synthesis of the published literature.


BACKGROUND
Safety concerns have driven specific interests in the accuracy and precision of pedicle screw placement. A large variation in reported accuracy may exist partly due to the lack of a standardized evaluation method and/or the lack of consensus to what, or in which range, is pedicle screw placement accuracy considered satisfactory.


METHODS
A MEDLINE search was executed covering the span from 1966 until 2006, and references from identified papers were reviewed. An extensive database was constructed for synthesis of the identified studies. Subgroups and descriptive statistics were determined based on the type of population, in vivo or cadaveric, and separated based on whether the assistance of navigation was employed.


RESULTS
In total, we report on 130 studies resulting in 37,337 total pedicle screws implanted, of which 34,107 (91.3%) were identified as accurately placed for the combined in vivo and cadaveric populations. The most common assessment method identified pedicle screw violations simply as either present or absent. Overall, the median placement accuracy for the in vivo assisted navigation subgroup (95.2%) was higher than that of the subgroup without the use of navigation (90.3%).


CONCLUSIONS
Navigation does indeed provide a higher accuracy in the placement of pedicle screws for most of the subgroups presented. However, an exception is found at the thoracic levels for both the in vivo and cadaveric populations, where no advantage in the use of navigation was found.
Kosmopoulos
Victor
V
Department of Orthopedics, Hôpital Orthopédique de la Suisse Romande, Lausanne, Switzerland. victor.kosmopoulos@yahoo.com
Schizas
Constantin
C
D001863:Bone Screws / Q000706:statistics & numerical data; D002574:Cervical Vertebrae / Q000601:surgery; D006801:Humans; D016268:Internal Fixators / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000601:surgery; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D011184:Postoperative Period; D013904:Thoracic Vertebrae / Q000601:surgery