PURPOSE Surgical treatment of severe adolescent idiopathic scoliosis (AIS) with posterior spinal instrumentation and fusion with pedicle screws is common, requiring careful screw insertion to prevent pedicle breaches and neurologic complications. Image guidance has been suggested to improve breach rates, though the radiation risk for AIS precludes its common usage. The purpose of this systematic review and meta-analysis was to compare the breach rates and screw-related complications for AIS patients undergoing spine surgery with pedicle screws between freehand screw insertion and image guidance methods. METHODS A comprehensive search of MEDLINE, EMBASE, CINAHL, CENTRAL and Web of Science databases was conducted. Two reviewers independently screened abstracts, full-texts, extracted data and performed risk of bias assessment using the QUIPS quality appraisal tool. Level of evidence summary statements were formulated based on consistency and quality of reporting. RESULTS Ninety-four studies were found, with 18 studies of moderate risk of bias or better. Moderate evidence from two head-to-head studies shows CT guidance has lower breach rates than freehand methods (OR 0.28 [0.20-0.40, I2 = 1%]), with no complications in either study. From individual studies, moderate evidence showed lower breach rates for image guidance versus freehand methods (13%, I2 = 98% vs. 20%, I2 = 95%). Complication rates were conflicting (0-1.6% for image guidance, 0-1.7% for freehand). Moderate evidence showed increased surgical time for image guidance versus freehand (257.7 min vs. 226.8 min). CONCLUSIONS Meta-analyzed breach rates show moderate evidence of decreased breaches with CT navigation compared with freehand methods. Complication rates remain unknown due to the low complication rates from small sample sizes. These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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影像引导能否减少青少年特发性脊柱侧弯手术治疗中椎弓根螺钉相关的并发症：系统评价更新和荟萃分析。

目的 使用后路脊柱内固定和椎弓根螺钉融合手术治疗严重的青少年特发性脊柱侧凸 (AIS) 很常见，需要小心插入螺钉以防止椎弓根断裂和神经系统并发症。虽然 AIS 的辐射风险排除了它的普遍使用，但已建议图像引导以提高违规率。本系统评价和荟萃分析的目的是比较手螺钉置入和图像引导方法之间使用椎弓根螺钉进行脊柱手术的 AIS 患者的破裂率和螺钉相关并发症。方法 对 MEDLINE、EMBASE、CINAHL、CENTRAL 和 Web of Science 数据库进行了全面搜索。两位审稿人独立筛选摘要、全文、使用 QUIPS 质量评估工具提取数据并进行偏倚风险评估。根据报告的一致性和质量制定证据级别总结陈述。结果 共发现 94 项研究，其中 18 项研究具有中等或更高的偏倚风险。来自两项头对头研究的中等证据表明，CT 引导的破坏率低于徒手方法（OR 0.28 [0.20-0.40，I2 = 1%]），两项研究均未出现并发症。从个别研究来看，中等证据显示图像引导与徒手方法相比具有较低的违规率（13%，I2 = 98% vs. 20%，I2 = 95%）。并发症发生率相互矛盾（图像引导为 0-1.6%，徒手为 0-1.7%）。中等证据显示，与徒手操作相比，图像引导的手术时间增加（257.7 分钟与 226.8 分钟）。结论 Meta 分析的违规率显示，与徒手方法相比，CT 导航减少了违规率的中等证据。由于小样本量的并发症发生率低，并发症发生率仍然未知。这些幻灯片可以在电子补充材料下检索。