caa a22 4500 445831545 CHVBK 20180317145316.0 cr unu---uuuuu 170323e20110601xx s 000 0 eng 10.1007/s00586-010-1577-5 doi (NATIONALLICENCE)springer-10.1007/s00586-010-1577-5 Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies [Elektronische Daten] [Nai-Feng Tian, Qi-Shan Huang, Ping Zhou, Yang Zhou, Rui-Kai Wu, Yi Lou, Hua-Zi Xu] Studies revealed that navigation systems that provided intraoperative assistance might improve pedicle screw insertion accuracy, and also implied that different systems provided different pedicle screw insertion accuracy. A systematic review and meta-analysis was conducted to focus on the pedicle screw insertion accuracy with or without the assistance of image-guided system, and the variance among the different navigation systems. Comparative studies were searched on pedicle screw insertion accuracy between conventional and navigated method, and among different navigation systems. A total of 43 papers, including 28 clinical, 14 cadaveric and 1 model studies, were included in the current study. For clinical articles, there were 3 randomized clinical trials, 4 prospective comparative studies and 21 retrospective comparative studies. The incidence of pedicle violation among computer tomography-based navigation method group was statistically significantly less than that observed among the conventional group (OR 95% CI, in vivo: 0.32-0.60; in vitro: 0.24-0.75 P<0.01). Two-dimensional fluoroscopy-based navigation system (OR 95% CI, in vivo: 0.27-0.48; in vitro: 0.43-0.88 P<0.01) and three-dimension fluoroscopy-based navigation system (OR 95% CI, in vivo: 0.09-0.38; in vitro: 0.09-0.36 P<0.01) also obtained significant reduced screw deviation rate over traditional methods. Between navigated approaches, statistically insignificant individual and pooled RR values were observed for all in vivo subgroups. Pooled estimate of in vitro studies show that computer tomography-based and three-dimension fluoroscopy-based navigation system provided more accurate pedicle screw insertion over two-dimension fluoroscopy-based navigation system. Our review showed that navigation provided a higher accuracy in the placement of pedicle screws compared with conventional methods. The superiority of navigation systems was obvious when they were applied to abnormal spinal structure. Although no strong in vivo evidence has detected significantly different pedicle screw placement accuracy among the three major navigation systems, meta-analysis revealed the variance in pedicle screw insertion accuracy with different navigation methods. Springer-Verlag, 2010 Navigated spine surgery nationallicence Pedicle screw nationallicence Computer tomography nationallicence Fluoroscopy nationallicence Accuracy nationallicence Tian Nai-Feng Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut Huang Qi-Shan Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut Zhou Ping Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut Zhou Yang Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut Wu Rui-Kai Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut Lou Yi Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut Xu Hua-Zi Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut European Spine Journal Springer-Verlag 20/6(2011-06-01), 846-859 0940-6719 20:6<846 2011 20 586 https://doi.org/10.1007/s00586-010-1577-5 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00586-010-1577-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tian Nai-Feng Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut NATIONALLICENCE 700 1- Huang Qi-Shan Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut NATIONALLICENCE 700 1- Zhou Ping Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut NATIONALLICENCE 700 1- Zhou Yang Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut NATIONALLICENCE 700 1- Wu Rui-Kai Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut NATIONALLICENCE 700 1- Lou Yi Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut NATIONALLICENCE 700 1- Xu Hua-Zi Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuanxi Road, 325000, Wenzhou, China aut NATIONALLICENCE 773 0- European Spine Journal Springer-Verlag 20/6(2011-06-01), 846-859 0940-6719 20:6<846 2011 20 586 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer