title: Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws.
abstract: 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.
authors.affiliation: Trauma and Orthopaedics, Huddersfield Royal Infirmary, Lindley, Huddersfield HD33EA, UK. rajeevverma12@rediffmail.com
authors.forename: Rajeev
authors.initials: R
authors.lastname: Verma
authors.forename: Sonal
authors.initials: S
authors.lastname: Krishan
authors.forename: Kurt
authors.initials: K
authors.lastname: Haendlmayer
authors.forename: A
authors.initials: A
authors.lastname: Mohsen
mesh_terms: 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