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. 2022 May;12(4):677-688.
doi: 10.1177/21925682211003552. Epub 2021 Mar 18.

Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis

Brigita De Vega  1 , Aida Ribera Navarro  1 , Alexander Gibson  2 , Deepak M Kalaskar  1   2
Affiliations

Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis

Brigita De Vega et al. Global Spine J. 2022 May.

Abstract

Study design: Systematic review and meta-analysis.

Objective: Various methods of pedicle screw (PS) placement in spinal fusion surgery existed, which can be grouped into conventional freehand (FH), modified freehand (MF), and image-guided methods (including fluoroscopy-based navigation (FL), computed tomography-based navigation (CT-nav), robot-assisted (RA), and ultrasound-guided (UG)). However, the literature showed mixed findings regarding their accuracy and complications. This review aimed to discover which method of PS placement has the highest accuracy and lowest complication rate in pediatric and adolescent spinal fusion surgery.

Methods: A comprehensive search in MEDLINE (PubMed), EMBASE (OVID), CENTRAL, and Web of Science was conducted until May 2020 by 2 independent reviewers, followed by bias assessment with ROB 2 and ROBINS-I tools and quantification with meta-analysis. Overall evidence quality was determined with GRADE tool.

Results: Four RCTs and 2 quasi-RCTs/CCTs comprising 3,830 PS placed in 291 patients (4-22 years old) were analyzed. The lowest accuracy was found in FH (78.35%) while the highest accuracy was found in MF (95.86%). MF was more accurate than FH (OR 3.34 (95% CI, 2.33-4.79), P < .00 001, I2 = 0%). Three-dimensional printed drill template (as part of MF) was more accurate than FH (OR 3.10 (95% CI, 1.98-4.86), P < .00 001, I2 = 14%). Overall, complications occurred in 5.84% of the patients with 0.34% revision rate. Complication events in MF was lower compared to FH (OR 0.47 (95% CI, 0.10-2.15), P = .33, I2 = 0%).

Conclusions: Meta-analysis shows that MF is more accurate than FH in pediatric and adolescent requiring PS placement for spinal fusion surgery.

Keywords: adolescents; meta-analysis; pediatrics; pedicle screws; spinal surgery; systematic review.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Various methods of pedicle screw (PS) placement.
Figure 2.
Figure 2.
PRISMA flow diagram of this review.
Figure 3.
Figure 3.
RCT and quasi-RCT assessment of the individual risk of bias with ROB 2.
Figure 4.
Figure 4.
Risk of bias of controlled clinical trial (CCT) assessed by ROBINS-I.
Figure 5.
Figure 5.
A meta-analysis of the accuracy of PS placement.
Figure 6.
Figure 6.
A meta-analysis of the postoperative complication rate.
Figure 7.
Figure 7.
Summary of findings and level of evidence of this review.
See this image and copyright information in PMC

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