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

De Vega, B; Navarro, AR; Gibson, A; Kalaskar, DM; (2021) Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis. Global Spine Journal 10.1177/21925682211003552. (In press). Green open access

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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.

Type: Article
Title: Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/21925682211003552
Publisher version: https://doi.org/10.1177%2F21925682211003552
Language: English
Additional information: © 2021 by AO Spine. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: adolescents, meta-analysis, pediatrics, pedicle screws, spinal surgery, systematic review
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Ortho and MSK Science
URI: https://discovery.ucl.ac.uk/id/eprint/10124804
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