Abstract
Background: Pedicle screws provide excellent fixation for a wide range of indications. However, their adoption in the cervical spine has been slower than in the thoracic and lumbar spine, which is largely due to the smaller pedicle sizes and the proximity to the neurovascular structures in the neck. In recent years, technology has been developed to improve the accuracy and thereby the safety of cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer-assisted Systems and 3D template moulds. We have performed a systematic review into the accuracy rates of the various systems. Methods: The PubMed and Cochrane Library databases were searched for eligible papers; 9 valid papers involving 1427 screws were found. Results: fluoroscopic methods achieved an 80.6% accuracy and navigation methods produced 91.4% and 96.7% accuracy for templates. Conclusion: Navigation methods are significantly more accurate than fluoroscopy, they reduce radiation exposure to the surgical team, and improvements in technology are speeding up operating times. Significantly superior results for templates over fluoroscopy and navigation are complemented by reduced radiation exposure to patient and surgeon; however, the technology requires a more invasive approach, prolonged pre-operative planning and the development of an infrastructure to allow for their rapid production and delivery. We affirm the superiority of navigation over other methods for providing the most accurate and the safest cervical pedicle screw instrumentation, as it is more accurate than fluoroscopy and lacks the limitations of templates.
Highlights
Complications from cervical spine surgery have the potential for catastrophic complications because of the proximity to the vertebral arteries, the airway and the spinal cord
Abumi demonstrated the safe use of cervical pedicle screws inserted using a combination of freehand and lateral fluoroscopic guidance, which has become the standard for cervical pedicle screw placement, but this is not without technical hurdles [5,6,7]
Lateral mass screw fixation has been used in the cervical spine since 1964, three decades before Abumi demonstrated the use of pedicle screws [23]
Summary
Complications from cervical spine surgery have the potential for catastrophic complications because of the proximity to the vertebral arteries, the airway and the spinal cord. Pedicle screws provide excellent biomechanical stability throughout the spine; its use in the cervical spine is limited by the technical challenges of instrumenting the narrow, oblique pedicles, and the risk of damage to the vertebral arteries [1,2,3,4]. Technology has been developed to improve the accuracy and thereby the safety of cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer-assisted Systems and 3D template moulds. Conclusion: Navigation methods are significantly more accurate than fluoroscopy, they reduce radiation exposure to the surgical team, and improvements in technology are speeding up operating times. Superior results for templates over fluoroscopy and navigation are complemented by reduced radiation exposure to patient and surgeon; the technology requires a more invasive approach, prolonged pre-operative planning and the development of an infrastructure to allow for their rapid production and delivery. We affirm the superiority of navigation over other methods for providing the most accurate and the safest cervical pedicle screw instrumentation, as it is more accurate than fluoroscopy and lacks the limitations of templates
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