Accuracy of Sub-axial Cervical Pedicle Screw Placement：A Systematic Review with the Meta-analysis Comparing Free-hand and Assistant Techniques
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摘要:
目的 系统比较徒手与辅助技术下颈椎椎弓根螺钉（sub-axial cervical pedicle screw sCPS）置入的准确性、螺钉穿破椎弓根方向以及螺钉相关并发症。 方法 检索Medline、Embase以及Cochrane数据库，收集2010年1月至2022年12月研究不同置钉技术下颈椎椎弓根螺钉置入准确性的高质量英文文献，根据纳入标准筛选文献、数据提取，使用RevMan 5.4进行Meta分析。 结果 共纳入26项研究，1697名患者，6654颗螺钉。Meta分析示：辅助技术置入sCPS有更高的准确率。穿破椎弓根外壁比内壁更常见，徒手技术置钉穿破上壁比下壁更常见，辅助技术置钉上壁和下壁穿破率，差异暂无统计学意义。 结论 （1）辅助技术较徒手技术对于置入sCPS有更高的准确性；（2）穿破椎弓根外壁和下壁比穿破内壁和上壁更常见；（3）sCPS置入的准确性评估需要统一的评估标准；（4）不同的辅助置钉技术各有优劣，应根据实际情况选择。 Abstract:Objective To systematically compare the accuracy, direction of pedicle screw perforation, and screw-related complications of sub-axial cervical pedicle screw （sCPS） placement with and without assistant techniques. Methods A total of 26 studies involving 1697 patients and 6654 screws were included. Medline, Embase, and Cochrane databases were searched to collect the high-quality English literature on the accuracy of cervical pedicle screw （CPS） placement using different screw placement techniques from 2010.1 to 2022.12. Literature was screened according to the inclusion criteria, data was extracted, and a meta-analysis was performed using RevMan 5.4. Results The meta-analysis showed that assistant techniques had a higher accuracy rate for sCPS placement. Perforation of the lateral wall of the pedicle was more common than the medial wall, and free-hand screw placement was more common in the superior wall than the inferior wall. There was no statistically significant difference in the perforation rate between the superior and inferior walls with assistant techniques. Conclusion 1. Assistant techniques has a higher accuracy rate for sCPS placement than free-hand techniques. 2. Perforation of the lateral and inferior walls of the pedicle is more common than perforation of the medial and superior walls. 3. A unified evaluation standard is needed for assessing the accuracy of sCPS placement. 4. Different assistant screw placement techniques have their own advantages and disadvantages, and should be selected according to the actual conditions. -
Key words:
- Systematic review /
- Pediclescrew /
- Sub-axial cervical
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图 2 徒手置钉技术与辅助置钉技术准确率的Meta分析
Figure 2. Meta analysis of the accuracy of free-hand techniques vs assisted techniques
图 3 徒手置钉组穿破椎弓根内外壁的森林图
Figure 3. Forest plot of the free-hand techniques group perforation the medial and lateral walls of the pedicle
图 4 徒手置钉组穿破椎弓根上下壁的森林图
Figure 4. Forest plot of the free-hand techniques group perforation the superior and inferior walls of the pedicle
图 5 徒手置钉组穿过椎弓根内外壁的漏斗图
Figure 5. Funne plot of the free-hand techniques group perforation the medial and lateral walls of the pedicle
图 6 辅助置钉组穿破椎弓根内外壁的Meta分析
Figure 6. Meta analysis of the assisted techniques group perforation the medial and lateral walls of the pedicle
图 7 辅助置钉组穿破椎弓根上下壁的Meta分析
Figure 7. Meta analysis of the assisted techniques group perforation the superiorly and inferiorly walls of the pedicle
图 8 辅助置钉组穿过椎弓根内外壁的漏斗图
Figure 8. Funne plot of the assisted techniques group perforation the medial and lateral walls of the pedicle
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[1] Abumi K,Itoh H,Taneichi H,et al. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: Description of the techniques and preliminary report[J]. Journal of Spinal Disorders,1994,7(1):19-28. doi: 10.1097/00002517-199407010-00003 [2] Abumi K,Shono Y,Ito M,et al. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine[J]. Spine,2000,25(8):962969. [3] Kotani Y,Cunningham B W,Abumi K,et al. Biomechanical analysis of cervical stabilization systems. An assessment of transpedicular screw fixation in the cervical spine[J]. Spine (Phila Pa,1976,),1994,19(22):2529-2539. [4] Jo D J,Seo E M,Kim K T,et al. Cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy[J]. J Korean Neurosurg Soc,2012,52(5):459-465. doi: 10.3340/jkns.2012.52.5.459 [5] Lee S H,Kim K T,Abumi K,et al. Cervical pedicle screw placement using the "key slot technique": The feasibility and learning curve[J]. J Spinal Disord Tech,2012,25(8):415-421. doi: 10.1097/BSD.0b013e3182309657 [6] Tofuku K,Koga H,Komiya S. Cervical pedicle screw insertion using a gutter entry point at the transitional area between the lateral mass and lamina[J]. Eur Spine J,2012,21(2):353-358. doi: 10.1007/s00586-011-1969-1 [7] Wang Y,Xie J,Yang Z,et al. Computed tomography assessment of lateral pedicle wall perforation by free-hand subaxial cervical pedicle screw placement[J]. Arch Orthop Trauma Surg,2013,133(7):901-909. doi: 10.1007/s00402-013-1752-3 [8] Liu J,Li Y,Wu Y,et al. A novel method of cervical pedicle screw placement from C3 to C5 and its clinical applications[J]. Spine (Phila Pa,1976,),2013,38(8):E504-E512. [9] Hojo Y,Ito M,Suda K,et al. A multicenter study on accuracy and complications of freehand placement of cervical pedicle screws under lateral fluoroscopy in different pathological conditions: CT-based evaluation of more than 1,000 screws[J]. Eur Spine J,2014,23(10):2166-2174. doi: 10.1007/s00586-014-3470-0 [10] Mahesh B,Upendra B,Mahan RS. The medial cortical pedicle screw-a new technique for cervical pedicle screw placement with partial drilling of medial cortex[J]. Spine J,2014,14(2):371-380. doi: 10.1016/j.spinee.2013.09.033 [11] Park J H,Jeon S R,Roh S W,et al. The safety and accuracy of freehand pedicle screw placement in the subaxial cervical spine: A series of 45 consecutive patients[J]. Spine (Phila Pa,1976,),2014,39(4):280-285. [12] Lee JH,Choi BK,Han IH,et al. Cervical sedicle screw placement using medial funnel technique[J]. Korean J Spine,2017,14(3):84-88. doi: 10.14245/kjs.2017.14.3.84 [13] Liu B,Liu X,Shen X,et al. The "slide technique"-a novel free-hand method of subaxial cervical pedicle screw placement[J]. BMC Musculoskelet Disord,2020,21(1):399. doi: 10.1186/s12891-020-03420-0 [14] Hey H W D,Zhuo W H,Tan Y H J,et al. Accuracy of freehand pedicle screws versus lateral mass screws in the subaxial cervical spine[J]. Spine Deform,2020,8(5):1049-1058. doi: 10.1007/s43390-020-00119-z [15] Garg B,Mehta N. Safety and feasibility of cervical pedicle screw insertion in pediatric subaxial cervical spine without navigation: A retrospective cohort study[J]. J Pediatr Orthop,2021,41(2):119-126. doi: 10.1097/BPO.0000000000001694 [16] V Rajan V,Kamath V,Shetty A P,et al. Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine[J]. Indian J Orthop,2010,44(2):163-168. doi: 10.4103/0019-5413.62083 [17] Zhang H L,Zhou D S,Jiang Z S. Analysis of accuracy of computer-assisted navigation in cervical pedicle screw installation[J]. Orthop Surg,2011,3(1):52-56. doi: 10.1111/j.1757-7861.2010.00110.x [18] Shimokawa N,Takami T. Surgical safety of cervical pedicle screw placement with computer navigation system[J]. Neurosurg Rev,2017,40(2):251-258. doi: 10.1007/s10143-016-0757-0 [19] Uehara M,Takahashi J,Ikegami S,et al. Screw perforation rates in 359 consecutive patients receiving computer-guided pedicle screw insertion along the cervical to lumbar spine[J]. Eur Spine J,2017,26(11):2858-2864. doi: 10.1007/s00586-016-4843-3 [20] Shi H,Zhu L,Ma J,et al. The accuracy of a novel pedicle screw insertion technique assisted by a special angular scale in the subaxial cervical spine using lateral mass as a reference marker[J]. J Orthop Surg Res,2020,15(1):551. doi: 10.1186/s13018-020-02054-1 [21] Rajasekaran S,Kanna P R,Shetty A P. Safety of cervical pedicle screw insertion in children: A clinicoradiological evaluation of computer-assisted insertion of 51 cervical pedicle screws including 28 subaxial pedicle screws in 16 children[J]. Spine (Phila Pa,1976,),2012,37(4):E216-E223. [22] Takahata M,Yamada K,Akira I,et al. A novel technique of cervical pedicle screw placement with a pilot screw under the guidance of intraoperative 3D imaging from C-arm cone-beam CT without navigation for safe and accurate insertion[J]. Eur Spine J,2018,27(11):2754-2762. doi: 10.1007/s00586-018-5706-x [23] Chachan S,Bin Abd Razak H R,Loo W L,et al. Cervical pedicle screw instrumentation is more reliable with O-arm-based 3D navigation: Analysis of cervical pedicle screw placement accuracy with O-arm-based 3D navigation[J]. Eur Spine J,2018,27(11):2729-2736. doi: 10.1007/s00586-018-5585-1 [24] Fujita R,Oda I,Takeuchi H,et al. Accuracy of pedicle screw placement using patient-specific template guide system[J]. Orthop Sci,2022,27(2):348-354. doi: 10.1016/j.jos.2021.01.007 [25] Kisinde S,Hu X,Hesselbacher S,et al. Robotic-guided placement of cervical pedicle screws: Feasibility and accuracy[J]. Eur Spine J,2022,31(3):693-701. doi: 10.1007/s00586-022-07110-4 [26] Ishikawa Y,Kanemura T,Yoshida G,et al. Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: A retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement[J]. Neurosurg Spine,2010,13(5):606-611. doi: 10.3171/2010.5.SPINE09993 [27] Liu Y J,Tian W,Liu B,et al. Comparison of the clinical accuracy of cervical (C2-C7) pedicle screw insertion assisted by fluoroscopy,computed tomography-based navigation,and intraoperative three-dimensional C-arm navigation[J]. Chin Med J (Engl),2010,123(21):2995-2998. [28] Nakashima H,Yukawa Y,Imagama S,et al. Complications of cervical pedicle screw fixation for nontraumatic lesions: A multicenter study of 84 patients[J]. Neurosurg Spine,2012,16(3):238-247. doi: 10.3171/2011.11.SPINE11102 [29] Yoshii T,Hirai T,Sakai K,et al. Cervical pedicle screw placement using intraoperative computed tomography imaging with a mobile scanner gantry[J]. Eur Spine J,2016,25(6):1690-1697. doi: 10.1007/s00586-016-4508-2 -
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