Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws.
A number of studies have shown increased accuracy of pedicle screw placement in spine with the help of computer-assisted navigation. The literature is lacking in regard to functional benefit derived from this technique. The aim of this systematic review was to look at the functional outcomes following computer-assisted pedicle screw placement in spine. A 'Dialog Datastar' search was used using optimized search strategy covering the period from 1950 to July 2009; 23 papers were finally included which met our inclusion criteria. We report on a total of 1,288 patients with 5,992 pedicle screws. The comparison of neurological complications in two groups demonstrated an odds ratio of 0.25 (95% CI 0.06, 1.14) in favour of using navigation for pedicle screw insertion (p = 0.07). Comparative trials demonstrated a significant advantage in terms of accuracy of navigation over conventional pedicle screw insertion with a relative risk of 1.12 (95% CI 1.09, 1.15) (p < 0.00001). Navigation does not show statistically significant benefit in reducing neurological complications and there was insufficient data in the literature to infer a conclusion in terms of fusion rate, pain relief and health outcome scores.
Verma
Rajeev
R
Trauma and Orthopaedics, Huddersfield Royal Infirmary, Lindley, Huddersfield HD33EA, UK. rajeevverma12@rediffmail.com
Krishan
Sonal
S
Haendlmayer
Kurt
K
Mohsen
A
A
D001863:Bone Screws / Q000009:adverse effects*; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects*; D013123:Spinal Fusion / Q000009:adverse effects*; D013131:Spine / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects*; D016896:Treatment Outcome