Charles Taylor, Chuck Lam, Nikhil Manoj, Omkaar Divekar
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引用次数: 0
Abstract
Background: Spinal fusion is a common form of orthopedic surgery, the most common of which involves pedicle screw placement (PSP). Despite well-documented benefits, pedicle screws are associated with several intraoperative complications. This area of surgery has subsequently been recipient to many surgical developments. Currently, augmented reality surgical navigation (ARSN) is at the forefront of surgical interest. This systematic review evaluates whether, when compared to freehand, fluoroscopic, and intraoperative image-guided navigation, ARSN results in superior screw accuracy and operative outcomes for patients undergoing PSP surgery.
Methods: Data collection was performed on PubMed, Ovid MEDLINE, the Cochrane Library, Embase, and the Web of Science between January 7, 2023, and January 8, 2024. PRISMA guidelines were followed and the level of evidence was graded per the Centre for Evidence-Based Medicine's recommendations. Risk of bias was assessed per the ROBINS-I tool and the Cochrane guide for assessing study quality. A modified version of the Newcastle-Ottawa Scale was used to determine the certainty of the body of evidence.
Results: A total of 521 papers were obtained from all bibliographical databases, 31 of which were included in the final review. ARSN resulted in a significantly greater number of screws placed as Gertzbein and Robbins grade 1 or 2 (93.33% vs 85.86%, p<0.000), significantly reduced intraoperative blood loss (470.32 vs 802.44 ml, p=0.050), comparative operative duration (281.6 vs 255.5 min, p=0.819), comparative time to place a screw (2.71 vs 3.1 min, p=0.703), and a nonsignificant reduction in hospital stay (5.4 vs 7.5 days, p=0.097). Maximum follow-up was more than 14 days.
Conclusions: ARSN results in a significantly greater number of screws placed at Gertzbein-Robertson grade 1 or 2 than non-ARSN surgery. Therefore, ARSN can be considered as a safe and efficacious technical innovation within PSP surgery.
背景：脊柱融合是一种常见的骨科手术形式，其中最常见的是椎弓根螺钉置入（PSP）。尽管有充分的证据证明椎弓根螺钉有好处，但仍与一些术中并发症有关。这一领域的外科手术随后成为许多外科发展的接受者。目前，增强现实手术导航（ARSN）是外科研究的前沿。本系统综述评估了与徒手、透视和术中图像引导导航相比，ARSN是否能使接受PSP手术的患者获得更好的螺钉精度和手术结果。方法：数据收集于2023年1月7日至2024年1月8日在PubMed、Ovid MEDLINE、Cochrane Library、Embase和Web of Science上进行。遵循PRISMA指南，并根据循证医学中心的建议对证据水平进行分级。根据ROBINS-I工具和Cochrane研究质量评估指南评估偏倚风险。纽卡斯尔-渥太华量表的修改版本被用来确定证据体的确定性。结果：在所有文献数据库中共获取论文521篇，其中31篇被纳入终评。ARSN在Gertzbein和Robbins 1级或2级时放置的螺钉数量显著增加（93.33% vs 85.86%）。结论：与非ARSN手术相比，ARSN在Gertzbein- robertson 1级或2级时放置的螺钉数量显著增加。因此，ARSN可以被认为是PSP手术中一项安全有效的技术创新。
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