While single-position surgery (SPS) eliminates the need for patient repositioning, the placement of screws in the unconventional lateral position poses unique challenges related to asymmetry relative to the surgical table. Use of robotic guidance or intraoperative navigation can help to overcome this. The aim of this study was to compare the relative accuracies offered by these various navigation modalities for pedicle screws placed in lateral SPS.
According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed/Medline, Embase, and Cochrane Library databases were queried for studies reporting pedicle screw placement accuracy using fluoroscopic, CT-navigated, O-arm, or robotic guidance in lateral SPS, and a systematic review and meta-analysis was performed. Included studies all compared evaluated screw placement accuracy in lateral SPS using a single navigation method. Quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system; risk of bias was assessed using the Newcastle-Ottawa Scale and the Joanna Briggs Institute checklist. The primary outcome, rate of pedicle screw breach, was analyzed using random-effects meta-analysis.
Eleven studies were included comprising 548 patients who underwent the placement of instrumentation with 2488 screws. For the fluoroscopic, CT-navigated, O-arm, and robotic guidance cohorts, there were 3, 2, 3, and 3 studies, respectively. Breach rates by modality were as follows: fluoroscopic guidance (6.6%), CT navigation (4.7%), O-arm (3.9%), and robotic guidance (3.9%). Random-effects meta-analysis showed a significant difference between studies, with an overall breach rate of 4.9% (95% CI 3.1%-7.5%; p < 0.001); however, testing for subgroup differences failed to show a significant difference between guidance modalities (QM = 0.69, df = 3; p = 0.88). Heterogeneity between studies was significant (I2 = 79.0%, τ2 = 0.41, χ2 = 47.65, df = 10; p < 0.001).
Robotic guidance of screws is noninferior to alternative guidance modalities in lateral SPS; however, additional prospective studies directly comparing different guidance types are merited.

BACKGROUND: Thoracolumbar fractures have the characteristics of acute onset, rapid change, and severe trauma. The best way to treat thoracolumbar fractures is through fracture reduction surgery. The surgical methods include percutaneous pedicle screw, posterior percutaneous pedicle screw internal fixation, and open pedicle screw internal fixation.
METHODS: We searched the PubMed, Embase, and Medline English database from April 1991 to April 2021, and the keywords included \"percutaneous tablet screen\", \"posterior percutaneous tablet screen fixation\", \"open tablet screen fixation\", \"fracture of thoracic vertebrae\", \"thoracic fractures\", \"thoracic\", and \"vascular fracture\". RevMan5.3 provided by Cochrane was used for meta-analysis.
RESULTS: A total of 9 articles were included in this study. Percutaneous pedicle screw fixation and posterior percutaneous pedicle screw fixation were adopted as the surgical methods, and patients were enrolled into experimental and control groups. Open pedicle screw internal fixation was set as the control group. The mean difference (MD) of operation time, blood loss, pain score, postoperative complications, screw debris rate, and hospital stay were -0.73, -192.16, -0.70, 1.49, 0.32, and -1.26, respectively; 95% confidence intervals (CIs) were (-0.94, -0.51), (-213.23, -171.09), (-0.82, -0.57), (0.47, 4.79), (0.10, 0.99), and (-1.82, -0.71), respectively; Z values were 6.71, 17.87, 10.95, 0.67, 1.97, and 4.46, respectively; and P values were <0.00001, <0.00001, <0.00001, 0.50, 0.05, and <0.00001, respectively.
CONCLUSIONS: A total of 9 articles were included in this meta-analysis. Compared with open surgery, the use of percutaneous pedicle screw and posterior percutaneous pedicle screw fixation had less blood loss, shorter operation time, shorter hospital stay, less pain, as well as lower screw dislocation and postoperative infection rates, indicating that the use of percutaneous pedicle screw and posterior percutaneous pedicle screw fixation is more effective than open surgery.

This study sought to 1) describe the use K-wireless pedicle screw insertion among adults (age ≥18 years) undergoing a minimally invasive fusion and 2) perform a systematic review (SR) of all studies that describe a navigated, K-wireless technique with 3-dimensional fluoroscopy.
Patients undergoing a minimally invasive fusion requiring pedicle screw fixation for any indication were prospectively enrolled in the observational component of this study. An assessment of pedicle breach was performed independently and in duplicate based on a modification of the Belmont grading scale. Articles for the SR were identified from a structured search of Medline from inception to May 8, 2019, without restriction of language.
A total of 82 pedicle screws were placed in 20 patients who underwent surgery between January and June 2014. There was no significant difference in mean operative time between the cases included in this study and a matched cohort of 20 patients undergoing surgery with 2-dimensional fluoroscopy and K-wire-assisted pedicle screw placement (95 ± 13 vs. 87 ± 20 minutes, respectively; P > 0.05). There were 2 major pedicle breaches (Belmont grade 3) in a single patient, yielding a major breach rate of 2.44%. A total of 6 papers that described the placement of 700 pedicle screws in 160 patients between May 2011 and March 2017 were included in the SR. The overall breach rate was 7.00% (n = 37).
Percutaneous pedicle screws can be placed accurately and safely using 3-dimensional navigation without the use of K-wires and may confer benefits to patients and clinicians by reducing K-wire-associated complications and radiation exposure.

BACKGROUND: Pedicle screw instrumentation provides a rigid construct to promote fusion in cases of spinal trauma and degenerative diseases. Minimally invasive percutaneous technique in lumbar spine is a safe and reliable procedure as compared to the well established Magerl technique. It is a straight forward alternative to open approaches or minimally invasive ones and the accuracy of screw placement is also similar to that reported for other techniques.
METHODS: A 16 year old high school boy presented to us with accidental fall from third floor. He was suffering from common cold with resulting high fever. He developed low back ache with bilateral radiculopathy and weakness of dorsiflexors. Neuro-imaging revealed a burst fracture of L4 vertebral body (type A 3.3 according to Magerl/AO spine classification), with bone fragments compromising the spinal canal. Delayed surgery was planned in view of anticipated excessive bleeding from the wound site in addition to poor general condition. Using a bone impactor, the bony fragments were impacted back into the original vertebral body space. Sextant (Medtronic Sofamor Danek, Tennessee, USA) percutaneous pedicle screw and rod fixation device was then used as a rigid construct to stabilize the lumbar spine. Post-operative CT scan and MRI revealed accurate pedicle screw fixation with adequately decompressed spinal canal.
CONCLUSIONS: Short segment fusion with minimally invasive pedicle screwing following decompression of cauda equina was considered to be a minimally invasive approach for this case.