A Network Meta-Analysis Comparing the Efficacy and Safety of Pedicle Screw Placement Techniques Using Intraoperative Conventional, Navigation, Robot-Assisted, and Augmented Reality Guiding Systems.

Autor:	Riewruja K; Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand., Tanasansomboon T; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand., Yingsakmongkol W; Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand., Kotheeranurak V; Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand., Limthongkul W; Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand., Chokesuwattanaskul R; Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand., Kerr SJ; Research Affair, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand., Singhatanadgige W; Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand dr.weerasaks@gmail.com.; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand.
Jazyk:	angličtina
Zdroj:	International journal of spine surgery [Int J Spine Surg] 2024 Nov 08; Vol. 18 (5), pp. 551-570. Date of Electronic Publication: 2024 Nov 08.
DOI:	10.14444/8618
Abstrakt:	Background: Studies were reviewed and collected to compare different image guidance systems for pedicle screw placement (PSP) regarding accuracy and safety outcomes. Included were conventional, navigation, robot-assisted, and recent technology such as augmented reality (AR) guiding systems. Methods: This network meta-analysis obtained human comparative studies and randomized controlled trials (RCTs) regarding PSP found in 3 databases (Cochrane, PubMed, and Scopus). Data extraction for accuracy, safety, and clinical outcomes were collected. The network meta-analysis was analyzed, and a surface under the cumulative ranking curve (SUCRA) was used to rank the treatment for all outcomes. Results: The final 61 studies, including 13 RCTs and 48 non-RCTs, were included in the meta-analysis. These studies included a total of 17,023 patients and 35,451 pedicle screws. The surface under the cumulative ranking curve ranking demonstrated the supremacy of robotics in almost all accuracy outcomes except for the facet joint violation. Regarding perfect placement, the risk difference for AR was 19.1 (95% CI: 8.1-30.1), which was significantly higher than the conventional method. The robot-assisted and navigation systems had improved outcomes but were not significantly different in accuracy vs the conventional technique. There was no statistically significant difference concerning safety or clinical outcomes. Conclusions: The accuracy of PSP achieved by robot-assisted technology was the highest, whereas the safety and clinical outcomes of the different methods were comparable. The recent AR technique provided better accuracy compared with navigation and conventional methods. (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2024 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)
Databáze:	MEDLINE
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