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Accuracy in Percutaneous Transpedicular Screws Placement Using Biplane Radioscopy

Systematic Review and Meta-Analysis

Rasmussen, Jorge Ariel, MD; Landriel, Federico, MD; Hem, Santiago, MD; Kornfeld, Sebastián, MD; Yampolsky, Claudio, MD

doi: 10.1097/BSD.0000000000000801

Study Design: Systematic review and descriptive data meta-analysis.

Objective: The objective of this study was to appropriately establish the accuracy in the percutaneous transpedicular screws (PTS) placement using biplane radioscopy (Rx-2D).

Summary of Background Data: The Rx-2D is a widely-used technique for PTS as it is practical, ubiquitous, and cost-effective. However, the reported “acceptable” accuracy attained by this method is widely variable ranging between 76% and 100%.

Methods: A systematic review was conducted to screen publications about PTS placement using Rx-2D guidance. PubMed/MEDLINE database was consulted using the search term “percutaneous pedicle screw” from 1977 to 2017. Previous meta-analysis and reference lists of the selected articles were reviewed. Accuracy values were assessed fulfilling the proposed criteria. Observational data meta-analysis was performed. Cochran’s Q test was used to determine heterogeneity among data extracted from the series, which was quantified by I2 test. P-values≤0.05 were considered statistically significant. The results were depicted by Forest plots. Funnel plots were outlined to visualize a possible bias of publication among the selected articles.

Results: In total, 27 articles were included in the analysis. Results of the accuracy were as follow, 91.5% (n=7993; 95% CI, 89.3%-93.6%) of the screws were placed purely intrapedicular, and 96.1% (n=8579; 95% CI, 94.0%-98.2%) when deviation from the pedicle was up to 2 mm.

Conclusions: This meta-analysis is the largest review of PTS placed with Rx-2D guidance reported up to date. We concluded that the procedure is a safe and reproducible technique. The key values obtained in this work set reliable references for both clinical and training outcome assessing.

Department of Neurosurgery, Italian Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina

The authors declare no conflict of interest.

Reprints: Jorge Ariel Rasmussen, MD, Department of Neurosurgery, Italian Hospital of Buenos Aires, Juan D. Perón 4190 (C1181ACH), Autonomous City of Buenos Aires, Argentina(e-mail:

Received June 27, 2018

Accepted January 8, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.