Abstract
Summary of Background Data
Several studies have shown that the accuracy of pedicle screw placement significantly improves with use of CT-based navigation systems. Yet, there has been no systematic review directly comparing accuracy of pedicle screw placement between different CT-based navigation systems. The aim of this study was to review the results presented in the literature and compare CT-based navigation systems relative to screw placement accuracy.
Methods
A systematic review of the literature was preformed using CENTRAL, Medline, PubMed and Embase databases. Studies included were randomized clinical trials, case series, and case control reporting the accuracy of pedicle screws placement using CT-based navigation. Two independent reviewers extracted the data from the selected studies that met our inclusion criteria. Papers were grouped based on the CT-based navigation system used for pedicle screws placement.
Results
33 Papers met all of our inclusion criteria and were included in the final analysis, which showed a significant statistical difference (P < 0.0001) in accuracy of pedicle screws placement between three different CT-based navigation systems. The mean (weighted) accuracy of pedicle screws placement based on the CT-based navigation system was found to be 96.8% ± 3.8% in StealthStation, 96.07% ± 3.8% in VectorVision and 97.7% ± 1.7% in SurgiGate. Post hoc analysis showed a significant statistical difference between StealthStation vs VictorVision (p < 0.0001) and StealthStation vs SurgiGate (p < 0.0001) as well.
Conclusion
This paper summarizes results presented in the literature and compares screw placement accuracy using different CT-based navigation systems. The differences in accuracy demonstrated in this review should be considered by spine surgeons, and need to be validated for effects on patients' outcome.
Level of Evidence
Level I.