Comparison of 3D-printed Navigation Template-assisted Pedicle Screws versus Freehand Screws for Scoliosis in Children and Adolescents: A Systematic Review and Meta-analysis

Chunli Lu; Longbing Ma; Xinyu Wang; Qingyu Yao; Can Zhang; Yueqi Du; Wei Li; Fengzeng Jian

doi:10.1055/a-1938-0254

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2023; 84(02): 188-197
DOI: 10.1055/a-1938-0254

Review Article

Comparison of 3D-printed Navigation Template-assisted Pedicle Screws versus Freehand Screws for Scoliosis in Children and Adolescents: A Systematic Review and Meta-analysis

Authors

Chunli Lu ‡^*

¹Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China

²Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China

³Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
Longbing Ma‡^*

¹Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China

²Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China

³Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
Xinyu Wang

¹Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China

²Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China

³Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
Qingyu Yao

¹Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China

⁴National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
Can Zhang

¹Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China

²Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China

³Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
Yueqi Du

¹Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China

²Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China

³Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
Wei Li

¹Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China

²Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China

³Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
Fengzeng Jian

¹Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China

²Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China

³Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China

Abstract

Background There is a lack of attention to screw placement techniques for surgical treatment of scoliosis in children and adolescents. This meta-analysis aims to compare the accuracy and safety of pedicle screw placement between the 3D-printed navigation template technique and the freehand technique during corrective surgery for scoliosis in children and adolescents.

Methods A comprehensive search was conducted for relevant articles up to December 2021 in databases including PubMed, Embase, MEDLINE, Cochrane, and Web of Science. The systematic meta-analysis compared the efficacy of pedicle screw placement between the two techniques, including accuracy of pedicle screw placement, complication rate, operation time, blood loss, mean placement time per screw, and mean times for fluoroscopy.

Results The seven articles analyzed in this study involved 229 patients altogether. A total of 2,805 pedicle screws were placed by the two methods. Our results revealed that the 3D-printed guide template technique was more accurate than the freehand technique in pedicle screw placement (odds ratio [OR] =2.96; 95% confidence interval [CI]: 2.24–3.91; p < 0.000) with a lower complication rate (OR = 0.21; 95% CI: 0.06–0.78; p = 0.02). The operation time (mean difference [MD] = –34.37; 95% CI: –67.47 to –1.28; p = 0.04) and mean placement time per screw (MD = –3.11; 95% CI: –6.13 to –0.09; p = 0.04) and mean times for fluoroscopy (MD = –6.60; 95% CI: –8.66 to –4.55; p < 0.000) significantly decreased among patients in the 3D-printed navigation template group compared with those in the freehand technique group. In addition, the two techniques had no significant statistical difference in blood loss.

Conclusions Compared with the traditional freehand technique, the 3D-printed guide template is a promising technique with higher accuracy and safety in screw placement for surgical treatment of scoliosis in children and adolescents, and is worth popularizing and validating through more prospective clinical studies.

Keywords

3D printing - drill guide template - freehand technique - pedicle screw - scoliosis

Full Text

References

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