Higher Accuracy and Better Clinical Outcomes in Navigated Thoraco-Lumbar Pedicle Screw Fixation versus Conventional Techniques: A Systematic Review and Meta-analysis.

ABSTRACT

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: This study aims to compare pedicle screw accuracy, clinical outcomes, and complications between navigated and conventional techniques. SUMMARY OF BACKGROUND DATA In the last decades, intraoperative navigation has been introduced in spinal surgery to prevent risks and complications. METHODS: The search was executed on Cochrane Central Library, PubMed and Scopus on 30 April 2023. Randomized controlled trials, prospective and retrospective studies that compared pedicle screw accuracy in the thoracic-lumbar-sacral segments, blood loss, operative time, hospital stay, intraoperative and postoperative revision of screws, neurological and systemic complications, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) between navigated and freehand or fluoroscopy-assisted techniques were included in this study. The meta-analysis was performed using Review Manager software. Clinical outcomes were assessed as continuous outcomes with mean difference, while pedicle screw accuracy and complications were assessed as dichotomous outcomes with odds ratio, all with 95% confidence intervals. The statistical significance of the results was fixed at P<0.05. RESULTS: This meta-analysis included 30 studies for a total of 17911 patients and 24600 pedicle screws. Statistically significant results in favour of the navigated technique were observed for accuracy of pedicle screws (P=0.0001), hospital stay (P=0.0002), blood loss (P<0.0001), postoperative revision of pedicle scews (P<0.00001), and systemic complications (P=0.0008). In particular, the positioning of the screws was clinically acceptable in 96.2% of the navigated group, and 94.2% with traditional techniques. No significant differences were found in VAS, ODI, and operative time between the two groups. CONCLUSION: Navigated pedicle screw fixation has been demonstrated to be a safe and effective technique with high improvement in clinical outcomes and accuracy in patients undergoing spinal fusion compared to conventional techniques. LEVEL OF EVIDENCE III.