Table 2.
Description of included experimental studies
| Study (year) | Study population (spinal level) | Interventions | Accuracy assessment | Conclusions |
|---|---|---|---|---|
| Choi et al. [40] | Six cadavers (T1–S1) | G1: CT Nav n = 6 (102 screws) G2: 2D FluoroNav n = 6 (106 screws) |
CT + dissection | Accuracy provided by 2D FluoroNav is comparable to CT Nav, but requires less time |
| Ludwig et al. [47] | Twelve fresh frozen cadavers (C3–C7) | G1: CT Nav n = 5 (50 screws) G2: Abumi technique n = 7 (67 screws) |
CT + dissection | Navigation system does not enhance accuracy compared with Abumi’s technique |
| Ludwig et al. [47] | Twelve fresh frozen cadavers (C3–C7) | G1: Abumi technique n = 4 (40 screws) G2: laminoforaminotomies + Abumi technique n = 4 (40 screws) G3: CT Nav n = 4 (37 screws) |
CT + dissection | Navigation system enhances accuracy of transpedicular screw placement, most notably at C6 and C7 |
| Assaker et al. [44] | Eight human cadavers (four thoracic, four lumbar) | G1: fluoroscopy n = 4 (40 screws) G2: CT Nav n = 4 (40 screws) |
X-ray + CT | Navigated pedicle screw insertion is more accurate than conventional method, but more time consuming |
| Austin et al. [39] | Seven embalmed cadavers: Four simulating posterolateral fusion model and three simulating non-fusion model (T6–S1) |
G1: fusion model; CT Nav n = 2 (24 screws) G2: fusion model; 2D FluoroNav n = 1 (12 screws) G3: fusion model; convention n = 1 (14 screws) G4: non-fusion model; 2D FluoroNav n = 2 (36 screws) G5: non-fusion model; convention n = 1 (14 screws) |
CT + dissection | Navigation improves pedicle screw insertion accuracy, particularly the CT Nav, and especially relevant clinically when the anatomy is obscured or altered |
| Mirza et al. [41] | Twenty fresh frozen cadavers (thoracic) | G1: 2D FluoroNav multi-reference n = 4 (70 screws) G2: 2D FluoroNav single reference n = 6 (99 screws) G3: standard fluoroscopy n = 6 (94 screws) G4: CT Nav n = 4 (74 screws) |
Anatomic dissection | A single reference-based 2D FluoroNav is highly inaccurate; systems with registration based on vertebrae are more accurate, but have more radiation exposure and more time is required |
| Sagi et al. [42] | Four fresh frozen cadavers (T1–T12) | G1: anatomic landmarks + fluoroscopy n = 2 (48 screws) G2: 2D FluoroNav n = 2 (48 screws) |
Anatomic dissection | 2D FluoroNav results in a similar incidence of safely placed screws as does conventional fluoroscopy, but reduced radiation exposure |
| Sagi et al. [43] | 16 fresh frozen cadavers (L1–L5) | G1: anatomic landmarks n = 6 (60 screws) G2: fluoroscopy n = 6 (60 screws) G3: 2D FluoroNav n = 4 (40 screws) |
Anatomic dissection | Usage of 2D FluoroNav in the lumbar spine results in improved accuracy, but requires increased time and does not decrease radiation exposure |
| Hart et al. [45] | Eight fresh cadavers (T1–T2, T4–T7, T9–T10) | G1: CT Nav n = 4 (64 screws) G2: fluoroscopy + manual technique n = 4 (64 screws) |
CT + dissection | No significant difference in pedicle violation between navigated and conventional method |
| Tian et al. [49] | Thirty-two embalmed cadavers (C3–C7) | G1: blind screw placement n = 8 (80 screws) G2: conventional fluoroscopy n = 8 (78 screws) G3: 2D FluoroNav n = 8 (80 screws) G4: CT Nav n = 8 (80 screws) G5: 3D FluoroNav n = 8 (80 screws) |
Anatomic dissection | Navigation enhances accuracies, 3D FluoroNav is the best among them |
| Arand et al. [11] | Nine spinal models (T6–T10, L1–L5) | G1: convention n = 3 (30 screws) G2: CT Nav n = 3 (30 screws) G3: 2D FluoroNav n = 3 (30 screws) |
Visually inspecting | Navigation techniques are superior to conventional method |
| Xia et al. [51] | Four cadavers (T7–S1) | G1: convention n = 2 (48 screws) G2: 2D FluoroNav n = 2 (48 screws) |
CT | 2D FluoroNav improves the accuracy of pedicle screw placement |
| John et al. [46] | NO. Cadavers unstated (T1–T6) | G1: CT Nav (20 screws) G2: fluoroscopy (20 screws) |
CT | CT Nav is superior to the conventional method in providing screw insertion accuracy |
| He et al. [50] | Ten cadavers (C2–C7) | G1: convention n = 5 (60 screws) G2: CT Nav n = 5 (60 screws) |
CT + dissection | CT Nav provides higher but insignificantly different accuracy than conventional method |
| Von Jako et al. [54] | Four fresh frozen cadavers (T8-S1) | G1: convention n = 2 (40 K-wires) G2: 2D FluoroNav n = 2 (40 K-wires) |
CT | 2D FluoroNav can provide high-accuracy K-wire placement in percutaneous transpedicular procedures |