Accuracy in Navigated Percutaneous Sacroiliac Screw Fixation: A Systematic Review and Meta-Analysis

Abstract

Abstract Background Percutaneous sacroiliac screw placement is a challenging procedure in patients with pelvic fractures. To overcome these challenges, navigated techniques have emerged as an alternative to conventional 2D fluoroscopy for guiding screw placement. However, it remains to be seen whether navigated techniques truly have a beneficial effect on accuracy, radiation exposure and occurrence of complications. Aims We performed a meta-analysis to investigate whether navigated techniques are superior to conventional 2D fluoroscopy in percutaneous sacroiliac screw fixation. Methods The electronic databases were searched for both randomized clinical trials and observational studies comparing percutaneous sacroiliac screw fixation with 2D fluoroscopy to new navigated techniques (2D or 3D fluoroscopic navigation with a c-arm, computer assisted ultrasound navigation, O-Arm navigation, mobile CT navigation, robotic navigation). Effects were pooled and presented as odds ratio, mean difference, and standardized mean difference with corresponding 95% confidence interval. Results In total 18 studies were included. New navigated techniques had a higher accuracy (81% versus 91% with MD 10%, 95% CI 5-14%). The greatest benefit in accuracy was found in studies with more advanced navigated techniques (O-Arm, mobile CT or robotic navigation). Also, fluoroscopy time (MD 72.13 seconds, 95% CI 7.73;92.91) and fluoroscopy frequency (MD 17.22 images in total, 95% CI 7.73;26.70) were lower for new navigated techniques. Radiation dose was higher for new navigated techniques (SMD 0.50, 95% CI 0.01;0.99). Surgery duration showed no significant difference. Similar results were found among in vitro studies. Complications were rare in both groups. Conclusion This meta-analysis demonstrated a higher accuracy of screw positioning, lower fluoroscopic frequency and time for navigated percutaneous sacroiliac screw fixation compared to conventional 2D fluoroscopy. Complications are acceptably low for both groups. Future studies should focus on which of the navigated techniques is the best and whether the implementation costs of a new technique outweigh its benefits.