• Giuseppe F Papalia, Gianluca Vadalà, Fabrizio Russo, Gianmarco Marcello, Niccolò Nardi, Rocco Papalia, and Vincenzo Denaro.
• Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy.
• Spine. 2024 Oct 1; 49 (19): 137013801370-1380.

Study DesignA systematic review and meta-analysis.ObjectiveThis study aims to compare pedicle screw accuracy, clinical outcomes, and complications between navigated and conventional techniques.Summary Of Background DataIn the last decades, intraoperative navigation has been introduced in spinal surgery to prevent risks and complications.Materials And MethodsThe search was executed on Cochrane Central Library, PubMed, and Scopus on April 30, 2023. Randomized controlled trials, prospective and retrospective studies that compared pedicle screw accuracy in the thoracic-lumbar-sacral segments, blood loss, operative time, hospital stay, intraoperative and postoperative revision of screws, neurological and systemic complications, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) between navigated and freehand or fluoroscopy-assisted techniques were included in this study. The meta-analysis was performed using Review Manager software. Clinical outcomes were assessed as continuous outcomes with mean difference, while pedicle screw accuracy and complications were assessed as dichotomous outcomes with odds ratio, all with 95% CIs. The statistical significance of the results was fixed at P <0.05.ResultsThis meta-analysis included 30 studies for a total of 17,911 patients and 24,600 pedicle screws. Statistically significant results in favor of the navigated technique were observed for the accuracy of pedicle screws ( P =0.0001), hospital stay ( P =0.0002), blood loss ( P <0.0001), postoperative revision of pedicle screws ( P <0.00001), and systemic complications ( P =0.0008). In particular, the positioning of the screws was clinically acceptable in 96.2% of the navigated group and 94.2% with traditional techniques. No significant differences were found in VAS, ODI, and operative time between the two groups.ConclusionNavigated pedicle screw fixation has been demonstrated to be a safe and effective technique with high improvement in clinical outcomes and accuracy in patients undergoing spinal fusion compared with conventional techniques.Level Of EvidenceLevel III.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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