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

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Abstract

Purpose

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.

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.

Results

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).

Conclusions

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.

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Acknowledgements

Elizabeth Dennett from the University of Alberta provided guidance on search terms and search strategy. Dr. Marc Moreau and Sarah Southon from Alberta Health Services and the Edmonton Scoliosis Clinic provided search terms and guidance on objectives and key outcomes for this study. Undergraduate student Suzana Trac helped with study de-duplication and study design assessment.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Andrew Chan

  2. Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada

    Eric Parent

  3. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Karl Narvacan

  4. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada

    Cindy San

  5. Department of Electrical Engineering, University of Alberta, Donadeo ICE 11-371, 9211-116 Street, Edmonton, AB, T6G 1H9, Canada

    Jason Wong & Edmond Lou

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  1. Andrew Chan
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Correspondence to Eric Parent.

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Chan, A., Parent, E., Wong, J. et al. Does image guidance decrease pedicle screw-related complications in surgical treatment of adolescent idiopathic scoliosis: a systematic review update and meta-analysis. Eur Spine J 29, 694–716 (2020). https://doi.org/10.1007/s00586-019-06219-3

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  • DOI: https://doi.org/10.1007/s00586-019-06219-3

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