STUDY DESIGN: Systematic review. OBJECTIVES: The aims of this systematic review were: (1) to determine the most commonly used methods for assessing pedicle screw placement accuracy, and (2) assess the difference in pedicle screw placement accuracy between navigation and free-hand techniques according to the classification method. BACKGROUND DATA: Pedicle screw fixation and spine surgery have almost become synonymous. However, there is currently no gold standard method to assess pedicle screw placement accuracy. We reviewed the literature to determine current techniques used by spine surgeons for the assessment of pedicle screw accuracy. METHODS: We systematically reviewed the medical literature (OVID Medline, Embase, PubMed) to identify all articles published between 2010 and 2013 that have assessed pedicle screw placement accuracy in humans. Two independent reviewers with a third independent mediator performed study screening, selection and data extraction using a blinded and objective protocol. RESULTS: A total of 68 relevant articles were included in this systematic review, for a total of 3442 patients, 60 cadavers and 43,305 pedicle screws. The most widely used method (37 articles) was based on 2 mm breach increments measured on computer tomography images. The second most widely used method consisted of an "in" or "out" classification system (16 articles). The remaining 15 articles used variable classification systems. Our result suggests that an average of 91.4% of pedicle screws placed with free-hand or fluoroscopy technique where within the safe zone (<2 mm breach) in comparison to an average of 97.3% of pedicle screws using navigation (p < 0.001) for the 2 mm increment method. Similarly, the in or out classification also showed statistically significant difference between free-hand and navigated techniques (p < 0.001). CONCLUSION: The grading system based on 2 mm increments seems to be the most widely accepted method for determining pedicle screw placement accuracy. All grading systems were based on imaging alone without taking into account the direction of the breach or patient's symptoms.
STUDY DESIGN: Systematic review. OBJECTIVES: The aims of this systematic review were: (1) to determine the most commonly used methods for assessing pedicle screw placement accuracy, and (2) assess the difference in pedicle screw placement accuracy between navigation and free-hand techniques according to the classification method. BACKGROUND DATA: Pedicle screw fixation and spine surgery have almost become synonymous. However, there is currently no gold standard method to assess pedicle screw placement accuracy. We reviewed the literature to determine current techniques used by spine surgeons for the assessment of pedicle screw accuracy. METHODS: We systematically reviewed the medical literature (OVID Medline, Embase, PubMed) to identify all articles published between 2010 and 2013 that have assessed pedicle screw placement accuracy in humans. Two independent reviewers with a third independent mediator performed study screening, selection and data extraction using a blinded and objective protocol. RESULTS: A total of 68 relevant articles were included in this systematic review, for a total of 3442 patients, 60 cadavers and 43,305 pedicle screws. The most widely used method (37 articles) was based on 2 mm breach increments measured on computer tomography images. The second most widely used method consisted of an "in" or "out" classification system (16 articles). The remaining 15 articles used variable classification systems. Our result suggests that an average of 91.4% of pedicle screws placed with free-hand or fluoroscopy technique where within the safe zone (<2 mm breach) in comparison to an average of 97.3% of pedicle screws using navigation (p < 0.001) for the 2 mm increment method. Similarly, the in or out classification also showed statistically significant difference between free-hand and navigated techniques (p < 0.001). CONCLUSION: The grading system based on 2 mm increments seems to be the most widely accepted method for determining pedicle screw placement accuracy. All grading systems were based on imaging alone without taking into account the direction of the breach or patient's symptoms.
Authors: Dennis P Devito; Leon Kaplan; Rupert Dietl; Michael Pfeiffer; Dale Horne; Boris Silberstein; Mitchell Hardenbrook; George Kiriyanthan; Yair Barzilay; Alexander Bruskin; Dieter Sackerer; Vitali Alexandrovsky; Carsten Stüer; Ralf Burger; Johannes Maeurer; Gordon D Donald; Donald G Gordon; Robert Schoenmayr; Alon Friedlander; Nachshon Knoller; Kirsten Schmieder; Ioannis Pechlivanis; In-Se Kim; Bernhard Meyer; Moshe Shoham Journal: Spine (Phila Pa 1976) Date: 2010-11-15 Impact factor: 3.468
Authors: Sheng Lu; Yuan Z Zhang; Zheng Wang; Ji H Shi; Yu B Chen; Xing M Xu; Yong Q Xu Journal: Med Biol Eng Comput Date: 2012-03-31 Impact factor: 2.602
Authors: Scott L Parker; Matthew J McGirt; S Harrison Farber; Anubhav G Amin; Anne-Marie Rick; Ian Suk; Ali Bydon; Daniel M Sciubba; Jean-Paul Wolinsky; Ziya L Gokaslan; Timothy F Witham Journal: Neurosurgery Date: 2011-01 Impact factor: 4.654
Authors: Ron von Jako; Michael A Finn; Kenneth S Yonemura; Ali Araghi; Larry T Khoo; John A Carrino; Mick Perez-Cruet Journal: Acta Neurochir (Wien) Date: 2010-12-14 Impact factor: 2.216
Authors: Christopher J Kleck; Ian Cullilmore; Matthew LaFleur; Emily Lindley; Mark E Rentschler; Evalina L Burger; Christopher M J Cain; Vikas V Patel Journal: Eur Spine J Date: 2015-09-22 Impact factor: 3.134