Pedicle Screw Insertion: Is O-Arm-Based Navigation Superior to the Conventional Freehand Technique? A Systematic...

Area of Science:

• Spine Surgery
• Surgical Navigation
• Orthopedics

Background:

• Limited clinical evidence compares O-arm-based navigation (ON) accuracy to the conventional freehand (FH) technique in spine surgery.
• Pedicle screw insertion accuracy is crucial for successful spinal procedures.

Purpose of the Study:

• To evaluate and compare the accuracy of pedicle screw insertion using ON versus the FH technique.
• To synthesize existing clinical evidence through a meta-analysis.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (Cochrane Library, Ovid, Web of Science, PubMed, Embase, CNKI) up to January 2020.
• Included prospective and retrospective comparative studies evaluating pedicle screw insertion accuracy.
• Statistical analysis used Stata 16.0, calculating odds ratios and confidence intervals, with heterogeneity assessed using chi-squared and I² statistics.

Main Results:

• Twenty reviews comprising 1422 patients and 9982 pedicle screws were analyzed.
• O-arm-based navigation (ON) demonstrated significantly higher accuracy than the freehand (FH) technique (OR, 2.46; 95% CI, 1.92-3.16; P = 0.021).
• Moderate statistical heterogeneity was observed (I² = 43.4%), which was reduced by subgroup analysis.

Conclusions:

• Navigation, specifically O-arm-based navigation (ON), enhances pedicle screw placement accuracy in spine surgery.
• ON may accelerate screw insertion and reduce associated complications compared to conventional freehand (FH) methods.
• Potential drawbacks include increased radiation exposure for patients and surgeons.