Does image guidance decrease pedicle screw-related complications in surgical treatment of adolescent idiopathic scoliosis: a systematic review update and meta-analysis

European spine journal

article

Andrew Chan¹  Eric Parent²  Jason Wong³  Karl Narvacan¹  Cindy San⁴  Edmond Lou³ 

[1] Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta;Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta;Department of Electrical Engineering, University of Alberta;Faculty of Pharmaceutical Sciences, University of British Columbia

关键词: Image guidance;    Spine surgery;    Systematic review;    Meta-analysis;    Pedicle breaches;   

DOI  :  10.1007/s00586-019-06219-3

来源: Springer

【 摘 要 】

Surgical treatment of severe adolescent idiopathic scoliosis (AIS) with posterior spinal instrumentation and fusion with pedicle screws is common, requiring careful screw insertion to prevent pedicle breaches and neurologic complications. Image guidance has been suggested to improve breach rates, though the radiation risk for AIS precludes its common usage. The purpose of this systematic review and meta-analysis was to compare the breach rates and screw-related complications for AIS patients undergoing spine surgery with pedicle screws between freehand screw insertion and image guidance methods. A comprehensive search of MEDLINE, EMBASE, CINAHL, CENTRAL and Web of Science databases was conducted. Two reviewers independently screened abstracts, full-texts, extracted data and performed risk of bias assessment using the QUIPS quality appraisal tool. Level of evidence summary statements were formulated based on consistency and quality of reporting. Ninety-four studies were found, with 18 studies of moderate risk of bias or better. Moderate evidence from two head-to-head studies shows CT guidance has lower breach rates than freehand methods (OR 0.28 [0.20–0.40, I2 = 1%]), with no complications in either study. From individual studies, moderate evidence showed lower breach rates for image guidance versus freehand methods (13%, I2 = 98% vs. 20%, I2 = 95%). Complication rates were conflicting (0–1.6% for image guidance, 0–1.7% for freehand). Moderate evidence showed increased surgical time for image guidance versus freehand (257.7 min vs. 226.8 min). Meta-analyzed breach rates show moderate evidence of decreased breaches with CT navigation compared with freehand methods. Complication rates remain unknown due to the low complication rates from small sample sizes. These slides can be retrieved under Electronic Supplementary Material.

【 授权许可】

Unknown