CT navigation in spinal deformity surgery

Introduction One of the most challenges in spinal deformity surgery is screw placement, which utilizes various methods and options for radiographic guidance, particularly computed tomography-based navigation (CT navigation). Discussions about the advantages and disadvantages of the technologies used determined the relevance of this study.
The aim of this study was to evaluate the effectiveness of intraoperative CT navigation in the surgical treatment of patients with spinal deformities using systematic data from the scientific literature.
Materials and Methods A literature search for studies evaluating the parameters of surgical interventions using CT navigation in spinal deformity surgery was conducted in Pubmed, EMBASE, ELibrary, and Google. The article type was a systematic review and meta-analysis, with a search depth of 10 years. The study was conducted in accordance with the PRISMA international guidelines for systematic reviews and meta‑analyses. Levels of evidence and strength of recommendations were assessed using the ACCO protocol. A  total of 40 articles were found in the databases, with 11 more articles in their reference lists, 48 of which were full‑text articles. Eight studies met the inclusion criteria, and two more were added in the sample by agreement of the authors. The following parameters were determined for analysis: screw placement accuracy, malposition rate and complications, operative time, blood loss, reoperation rate, reference frame positioning, and radiation exposure.
Results and discussion The analysis revealed the advantages of using intraoperative CT navigation for screw placement. CT navigation improves screw placement accuracy, does not increase surgical time, and  does not  reduce the effectiveness of deformity correction. Surgery time, blood loss, and radiation exposure with  CT navigation are comparable to other methods. Positioning of one reference frame significantly reduces surgical time, does not affect screw placement accuracy, and does not require additional CT scanning, thereby reducing radiation exposure. To reduce radiation exposure, it is recommended to set a scanning mode with a reduced radiation dose.
Conclusion CT navigation offers advantages in terms of screw placement accuracy, lower malposition rates and associated complications, and reduced reoperation rates. The high safety profile of the navigation system is due not only to the increased accuracy of screw placement but also to lower complication rates.

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