Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw placement: a meta-analysis.

Area of Science:

• Spine Surgery
• Orthopedic Technology
• Medical Imaging

Background:

• Intraoperative computer navigation for thoracic pedicle screw placement (PSs) is established but its safety and practicality are debated.
• Thoracic diseases like scoliosis and kyphosis often require pedicle screw fixation.

Purpose of the Study:

• To evaluate the accuracy, operative time, blood loss, insertion time, and complication rates of computer navigation versus fluoroscopy-guided thoracic pedicle screw placement.
• To compare the safety and reliability of these two techniques in spinal fusion.

Main Methods:

• A systematic literature search was conducted on PubMed, Web of Knowledge, and Google Scholar.
• Comparative studies of thoracic pedicle screw placement using computer navigation and fluoroscopy were identified and analyzed.
• Outcomes including malposition rate, operative time, insertion time, blood loss, and complications were evaluated across 14 studies involving 1723 patients and 9019 PSs.

Main Results:

• Computer navigation showed a significantly lower malposition rate (RR: 0.33) and fewer complications (RR: 0.23) compared to fluoroscopy.
• Operative time was longer with computer navigation (WMD: 23.66 min), but pedicle insertion time was shorter (WMD: -1.88 min).
• Intraoperative blood loss was reduced with computer navigation (WMD: -167.49 mL).

Conclusions:

• Computer navigation for thoracic pedicle screw placement is associated with a lower malposition rate, reduced intraoperative blood loss, and fewer complications.
• The findings provide strong evidence supporting computer navigation as a safer and more reliable technique than fluoroscopy-guided navigation for thoracic spinal fusion.