COMPARISON OF MAJOR SPINE NAVIGATION PLATFORMS BASED ON KEY PERFORMANCE METRICS: A META-ANALYSIS OF 16,040 SCREWS

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Navigation technologies continue to develop and aid the instrumentation of spinal hardware. This meta-analysis attempted to evaluate all available published literature on computer-assisted spine navigation to compare the placement accuracy and surgical outcomes of prominent platforms such as Medtronic, Brainlab, and Stryker, using conventional techniques (free-hand or fluoroscopy) as a common control. Literature searches were performed using OVID MEDLINE and EMBASE databases. Included studies must have performed postoperative computed tomography to evaluate screw placement. Screw placement accuracy, neurologic complications, operative time, and blood loss were then analysed directly via network meta-analysis. Among the 28 included studies, 2959 patients underwent spinal instrumentation surgery, of which 1471 patients were in the navigation group and 1488 patients in the conventional group. Average age of patients in the navigation and conventional groups were 59.1 and 57.8 years old, respectively. 16,040 screws were included of which 7957 screws were placed using navigation technologies and 8083 screws were placed using conventional methods. Navigation manufactures included in the pooled analysis were Medtronic (15 studies, screws=9421), BrainLab (8 studies, screws=4778), Stryker (4 studies, screws=1684), and SeaSpine (7D Surgical) (1 study, screws=157). At all spinal levels, there was a significantly lower risk of major breach and improved screw accuracy in the navigation group compared to the conventional group (OR 0.42, 95% CI 0.27 to 0.63, p<0.0001, I2 = 56%, random effect model). Across platforms, Stryker demonstrated the highest screw accuracy with an 84% reduction in risk of breach (OR 0.16 95% CI 0.06 to 0.41, P < 0.00001, I2 = 0%, REM), followed by Medtronic and then Brainlab. Additionally, there were no significant differences in secondary surgical outcomes including rates of neurologic complications and blood loss between navigation platforms. However, BrainLab demonstrated significantly faster operative time compared to Medtronic by approximately 30 minutes (95% CI −63.27 to −2.47, p=0.03, I2=74%). Our results indicate that use of computer-assisted navigation platforms in spine surgery leads to an approximately 60% reduction in risk of major breach compared to conventional methods, with Stryker demonstrating the highest accuracy among platforms. Furthermore, we demonstrated that this increased accuracy is without negative change to surgical outcomes such as neurologic complications and blood loss. Although the studies analysed are highly heterogeneous, this study is the first to directly and quantitatively compare available navigation platforms. As such, our findings provide a foundation for further investigations and offer insight in guiding the acquisition of navigation platforms by surgeons and institutions.

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