Comparing Accuracy and Operation Time of Different Pedicle Fixation Methods in Congenital Scoliosis: A Bayesian Network Meta-analysis

Introduction: Pedicle screw fixation is a commonly used surgical technique in arthrodesis in the treatment of congenital scoliosis. Precise pedicle screw insertions can be difficult, especially for patients with more complicated deformities like congenital scoliosis. The use of alternatives to the classic freehand technique (FH), such as spinal computed tomography navigation systems (CTN), robotic assistance (RBN), and 3D printed-assisted navigation templates (3DN), could improve the accuracy of pedicle screw placement. This paper aims to review current evidence, comparing these different techniques of screw placement in congenital scoliosis surgery.

Methods: Randomized studies from Pubmed, Embase, Scopus, Cochrane Library and Web of science until November 1st, 2024 were included, and the study population was patients under 25 years with congenital scoliosis. Bayesian NMA was employed to calculate odds-ratio (OR) and estimate the relative effects of each approach. Accuracy of screw placement was evaluated by the Gertzbein-Robbin classification system.

Results: Nine studies were included. The analysis demonstrated that 3DN significantly improved the odds of achieving Grade 0 screw placement compared to FH (OR 2.2, 95% CI: 1.05, 4.84). FH was associated with a higher likelihood of incorrectly placed Grade 2+3 screws when compared with 3DN (OR 3.588, 95% CI: 2.357, 6.365), CTN (OR 5.875, 95% CI: 2.462, 16.69), and RBN arm (OR 5.084, 95% CI: 1.064, 25.959). Additionally, FH accuracy was lower than 3D-N (OR 0.284, 95% CI: 0.161, 0.436), and RBN (OR 0.199, 95% CI: 0.036, 0.997) for Grade 0+1 placements. RBN arm demonstrated the highest probability of achieving first place for Grade 0 accuracy (0.4196), while CTN stood out with the highest probability of ranking first for both the Grade 0+1 accuracy levels. No statistically significant differences in operation time (OT) were found across techniques.

Conclusion : 3DN may offer superior accuracy in pedicle screw placement compared to FH, which exhibited the poorest results. Also, 3DN doesn't have inferior accuracy compared to CTN and RBN. Although these navigation aids enhanced screw placement accuracy, no statistically significant differences in OT were found across techniques.