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Table 2 Characteristics of included studies and quality assessment

From: Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis

Author(s) [Ref.]

Year

Country

Number of C2 screws used

Sample size (n)

Age mean (SD, range) years

Gender ratio (M:F)

Design

Assessing C2 screw placement accuracy classification

Accuracy rate (%)

Study quality

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Pedicle

Pars

Pedicle

Pars

     

Pedicle

Pars

Pedicle

Pars

 

Abumi et al. [11]

2000

Japan

74

NR

NR

NR

74 out of 669 screw of 180 patients

70 (13–84) of 180 patients

106:74

Retrospective

Post-op CT, without classification

95.9 (71/74)

NR

NR

NR

6

Harms et al. [12]

2001

Germany

74

NR

NR

NR

37

49 (2–90)

19:18

Retrospective

Postoperative X-rays, without classification

100 (74/74)

NR

NR

NR

6

Goel et al. [13]

2002

India

320

NR

NR

NR

160

23 (1.7–79)

91:69

Retrospective

Satisfactory was considered, if the screw did not protrude more than 4 mm beyond the anterior cortex of the lateral mass of the atlas and axis

98.1 (314/320)

NR

NR

NR

8

Chen et al. [14]

2005

Taiwan

22

NR

NR

NR

11

48.6 (21–73)

8:3

Retrospective

Post-op CT, without classification

86.4 (19/22)

NR

NR

NR

5

Ondra et al. [15]

2006

USA

117

33

NR

NR

79

48 (15–91)

45:34

Retrospective

Post-op CT, without classification

91.4 (107/117)

96.9 (32/33)

NR

NR

7

Stulik et al. [16]

2007

Czech Republic

56

NR

NR

NR

28

59.5 (23–89)

18:10

Retrospective

Post-op CT, without classification

94.6 (53/56)

NR

NR

NR

6

Yeom et al. [17]

2008

South Korea

39

NR

NR

NR

23

47 (7–69)

15:8

Retrospective

Modified Gertzbein and Robbins

79.5 (31/39)

NR

NR

NR

7

Li et al. [18]

2008

China

42

NR

NR

NR

23

38 (19–52)

16:7

Retrospective

Postoperative X-rays, without classification

100 (42/42)

NR

NR

NR

6

Sciubba et al. [19]

2009

USA

100

NR

NR

NR

55

56.7 (14–87)

31:24

Prospective

Sciubba et al. classification

85 (85/100)

NR

NR

NR

8

Parker et al. [20]

2009

USA

161

NR

NR

NR

85

59.2 (18.1)

57:28

Retrospective

A breach was defined > 20% of screw outside of pedicle

93.1 (150/161)

NR

NR

NR

8

Yukawa et al. [21]

2009

Japan

23

NR

NR

NR

23 out of 620 screw of 144 patients

44.1 (14–90) of 144 patients

125:19

Retrospective

Yukawa et al. classification

65.2 (15/23)

NR

NR

NR

7

Payer et al. [22]

2009

Switzerland

NR

24

NR

NR

12

58 (23–78)

8:4

Prospective

Post-op CT, without classification

NR

91.7 (22/24)

NR

NR

5

De Iure et al. [23]

2009

Italy

20

NR

NR

NR

12

33.4 (14–62)

6:6

Retrospective

Post-op CT, without classification

100 (20/20)

NR

NR

NR

5

Simsek et al. [24]

2009

Turkey

34

NR

NR

NR

17

40 (6–74)

13:4

Retrospective

Post-op CT, without classification

100 (34/34)

NR

NR

NR

5

Tan et al. [25]

2009

China

22

NR

NR

NR

11 out of 17 patients

42.5 (25–67) of 17 patients

12:5

Retrospective

Post-op CT, without classification

100 (22/22)

NR

NR

NR

5

Xie et al. [26]

2009

China

50

NR

NR

NR

25

42 (18–70)

15:10

Retrospective

Post-op CT, without classification

100 (50/50)

NR

NR

NR

6

Miyamoto et al. [27]

2009

Japan

32

NR

NR

NR

32 out of 130 screw of 29 patients

61.2 (17.4)

19:10

Retrospective

Neo et al. classification

100 (32/32)

NR

NR

NR

7

Mueller et al. [28]

2010

Germany

47

NR

NR

NR

27

56 (22)

13:14

To 24-month postoperatively

Modified Gertzbein and Robbins

82.9

NR

NR

NR

8

Alosh et al. [29]

2010

USA

170

NR

NR

NR

93

57.9 (17.4)

59:34

Retrospective

Modified Gertzbein and Robbins

74.7 (127/170)

NR

NR

NR

8

Wang et al. [ 30]

2010

USA

638

NR

NR

NR

319

38.3 (4–73)

195:124

Retrospective

Wang et al. classification

92.8 (592/638)

NR

NR

NR

8

Lee et al. [30]

2010

South Korea

54

NR

NR

NR

27

51 (7–79)

11:16

Retrospective

Post-op CT, without classification

98.1 (53/54)

NR

NR

NR

6

Mummaneni et al. [31]

2010

USA

NR

76

NR

NR

38 out of 42 patients

64 (19–91)

24:18

Retrospective

Post-op CT, without classification

NR

100 (76/76)

NR

NR

6

Ni et al. [32]

2010

China

26

NR

NR

NR

13

48.5 (32–65)

9:4

Retrospective

Post-op CT, without classification

100 (26/26)

NR

NR

NR

5

Bransford et al. [33]

2011

USA

260

56

NR

NR

328

Over 7 years

188:140

Retrospective

Upendra et al. classification

98.8 (257/260)

94.6 (53/56)

NR

NR

9

Ishikawa et al. [34]

2011

Japan

NR

NR

24

NR

24 out of 108 screw of 21 patients

67.2 (42–83) of 21 patients

9:12

Retrospective

Neo et al. classification

NR

NR

Overall 88.9

NR

7

Hamilton et al. [35]

2011

USA

80

8

NR

NR

44

71 (67–89 )

23:21

Retrospective

Post-op CT, without classification

100 (80/80)

100 (8/8)

NR

NR

7

Chun et al. [36]

2011

South Korea

30

NR

NR

NR

15

56.8 (27–74 )

5:10

Retrospective

Post-op CT, without classification

100 (30/30)

NR

NR

NR

5

Nitising et al. [37]

2011

Thailand

NR

20

NR

NR

10

15–59

7:3

Retrospective

Post-op CT, without classification

NR

100 (20/20)

NR

NR

5

Lee et al. [38]

2011

South Korea

82

6

NR

NR

44

47.7 (4–84)

28:16

Retrospective

Post-op CT, without classification

95.1 (78/82)

100 (6/6)

NR

NR

7

Kang et al. [39]

2012

USA

NR

32

NR

NR

20

66 (19–89 )

9:11

Retrospective

Post-op CT, without classification

NR

96.9 (31/32)

NR

NR

5

Kawaguchi et al. [40]

2012

Japan

16

NR

NR

NR

16 out of 44 screw of 11 patients

57.4 (14–78 )

2:9

Retrospective

Neo et al. classification

100 (16/16)

NR

NR

NR

7

Ringel et al. [41]

2012

Germany

68

NR

NR

NR

35

64 (8–90)

20:15

Prospective

Post-op CT, without classification

82.3 (56/68)

NR

NR

NR

5

Jeon et al. [42]

2012

South Korea

28

6

NR

NR

17

40.4 (15–68)

9:8

Retrospective

Post-op CT, without classification

96.4 (27/28)

100 (6/6)

NR

NR

6

Tauchi et al. [43]

2013

Japan

NR

NR

37

NR

37 out of 196 screw of 46 patients

53.2 (5–84) of 46 patients

NR

Retrospective

Neo et al. classification

NR

NR

Overall 87.8

NR

6

Wu et al. [44]

2013

China

20

NR

NR

NR

10

45 (38–82)

6:4

Retrospective

Perforations of the pedicle wall (< 2 mm)

85 (17/20)

NR

NR

NR

7

Ling et al. [45]

2013

Singapore

20

NR

NR

NR

20 out of 103 screw of 21 patients

43 (6–83)

12:9

Retrospective

Neo et al. classification

90 (18/20)

NR

NR

NR

7

Yang et al. [46]

2013

China

24

NR

24

NR

24

45.9 (4.9)

11:13

Retrospective

Modified Neo et al. classification

95.8 (23/24)

NR

100 (24/24)

NR

9

Bydon et al. [47]

2014

USA

341

NR

NR

NR

181

57.9 (15.1)

101:80

Retrospective

Sciubba et al. classification

77.4 (264/341)

NR

NR

NR

8

Hojo et al. [48]

2014

Japan

148

NR

NR

NR

148 of 1065 screw of 283 patients

57.4 (14–87) out of 283 patients

183:100

Retrospective

Neo et al. classification

77.1 (114/148)

NR

NR

NR

8

Uehara et al. [49]

2014

Japan

NR

NR

33

NR

33 of 579 screw of 129 patients

63.4 (14.4) out of 129 patients

82:47

Retrospective

Uehara et al. classification

NR

NR

87.9 (29/33)

NR

8

Singh et al. [50]

2014

India

NR

NR

20

NR

10

17–81

9:1

Retrospective

Modified Gertzbein and Robbins classification

NR

NR

95 (19/20)

NR

7

Yu et al. [51]

2014

China

NR

NR

26

NR

26 of 108 screw of 23 patients

33.5 (19–52) of 23 patients

11:12

Retrospective

3D CT at the end of the procedure

NR

NR

96.1 (25/26)

NR

7

Tao et al. [52]

2014

China

NR

NR

64

6

70 out of 196 screw out of 99 patients

35 out of 99 patients

53:46

Retrospective

Modified Gertzbein and Robbins classification

NR

NR

89.1 (57/64)

100 (6/6)

9

Kim et al. [53]

2014

South Korea

NR

NR

32

NR

32 of 58 screw of 18 patients

45.8 (24–72)

13:5

Retrospective

Modified Neo et al. classification

NR

NR

84.3 (27/32)

NR

7

Kaneyama et al. [54]

2014

Japan

26

12

NR

NR

38 of 48 screw of 23 patients

69.4 (54–86)

10:13

Prospective

Neo et al. classification

100 (26/26)

100 (12/12)

NR

NR

8

Yang et al. [55]

2014

China

40

NR

NR

NR

20

40.2 (8–63)

11:9

Retrospective

Post-op CT, without classification

97.5 (39/40)

NR

NR

NR

6

Bredow et al. [56]

2015

Germany

NR

NR

65

NR

28

63.8 (16.8)

16:12

NR

Modified Gertzbein and Robbins classification

NR

NR

95.4

NR

8

Qi et al. [57]

2015

China

42

NR

NR

NR

21

46.5 (24–69)

13:8

Retrospective

Post-op CT, without classification

100 (42/42)

NR

NR

NR

6

Shih et al. [58]

2015

Taiwan

26

NR

NR

NR

13 of 35 patients

55.3 (21–7)

18:17

Retrospective

Post-op CT, without classification

96.1 (25/26)

NR

NR

NR

5

Lang et al. [59]

2016

China

NR

NR

40

NR

20

35.1 (18–55)

15:5

Retrospective

Gertzbein and Robbins classification

NR

NR

89.3% (50/56)

NR

8

Zheng et al. [60]

2016

China

172

NR

NR

NR

86

42.6 (16–69)

48:38

Retrospective

Post-op CT, without classification

100 (172/172)

NR

NR

NR

6

Zhao et al. [61]

2017

China

NR

NR

24

NR

12

37.4 (18–47)

12:0

Retrospective review of a prospectively collected data

3D CT at the end of the procedure

NR

NR

95.8 (23/24)

NR

7

Uehara et al. [62]

2017

Japan

NR

NR

40

NR

40 of 3413 screw of 359 patients

43 (26.9) of 359 patients

147:212 of 359 patients

Retrospective

Rao et al. classification

NR

NR

95 (38/40)

NR

8

Singh et al. [63]

2017

India

NR

NR

30

NR

15

34.4 (17–81)

13:2

Retrospective

Gertzbein and Robbins classification

NR

NR

93.3 (28/30)

NR

7

Shimokawa et al. [64]

2017

Japan

NR

NR

114

NR

114 of 762 screw of 128 patients

65.5 (15–92)

84:44 of 128 patients

Retrospective

Neo et al. classification

NR

NR

99.1 (113/114)

NR

8

Sugawara et al. [65]

2017

Japan

20

NR

NR

NR

20 of 48 screw of 12 patients

42–77

6:6

Prospective

3D/multiplanar imaging software

100 (20/20)

NR

NR

NR

7

Liu et al. [66]

2017

China

62

NR

NR

NR

31

51 (45–62)

18:13

Prospective

Post-op CT, without classification

100 (62/62)

NR

NR

NR

6

Jacobs et al. [67]

2017

Germany

NR

NR

60

NR

30

52 (3–91)

22:8

Retrospective

Gertzbein and Robbins classification

NR

NR

100 (60/60)

NR

8

Cao et al. [68]

2017

China

174

NR

NR

NR

87

39.2 (25–55)

NR

Retrospective

Modified Gertzbein and Robbins classification

95.9 (167/174)

NR

NR

NR

8

Guo et al. [70 ]

2017

China

25

NR

NR

NR

13

45.1 (25–57)

6:7

Prospective

Accuracy of the screw fixation was evaluated with the Mimics15.0 software

Overall 94.6

NR

NR

NR

6

Jiang et al. [71 ]

2017

China

108

NR

NR

NR

54

45.3 (12–54)

34:20

Prospective

Modified Gertzbein and Robbins

Overall 92.6

NR

NR

NR

7

Wu et al. [69]

2017

China

40

NR

NR

NR

20

NR

NR

Prospective

Accuracy of the screw fixation was evaluated with the Mimics software

100

NR

NR

NR

8

Pu et al. [70]

2018

China

34

NR

NR

NR

17

43.3 (25–56)

11:6

Retrospective

Kawaguchi et al. classification

Overall 97.06

NR

NR

NR

6

Pu et al. [71]

2018

China

98

NR

NR

NR

49

22–56

25:24

Retrospective

Kawaguchi et al. classification

Overall 86.5

NR

NR

NR

7

Sugawara et al. [72]

2018

Japan

138

NR

NR

NR

138 out of 813 screw of 103 patients

15–85

57:46

Prospective

3D/multiplanar imaging software

100 (138/138)

NR

NR

NR

8

Punyarat et al. [5]

2018

Thailand

52

87

NR

NR

76

59.9 (20–86)

42:34

Retrospective

Sciubba et al. classification

76.9 (40/52)

88.5 (77/87)

NR

NR

9

Pham et al. [73]

2018

USA

40

NR

NR

NR

24

56.1 (23–91)

18:6

Retrospective

Sciubba et al. classification

82.5 (33/40)

NR

NR

NR

8

Ould-Slimane et al. [74]

2018

France

NR

NR

22

NR

11

55 (22–69)

6:5

Prospective

No cortical breach was detected using cone-beam CT at the end of the procedure

NR

NR

100

NR

5

Chachan et al. [75]

2018

Singapore

NR

NR

32

NR

32 of 241 screw of 44 patients

62.1 (34–81)

27:17

Retrospective

Gertzbein and Robbins classification

NR

NR

100

NR

7

Marco et al. [76]

2018

USA

29

NR

NR

NR

22 of 30 patients

54 (6–87)

15:15

Retrospective

One cortical breach, which measured less than 2 mm, was detected.

96.5 (28/29)

NR

NR

NR

5

Sai Kiran et al. [77]

2018

India

24

49

NR

NR

94

30 (16.3)

61:33

Retrospective

Upendra et al. classification

100 (24/24)

100 (49/49)

NR

NR

9

Işik et al .[78]

2018

Turkey

24

8

NR

NR

16 of 28 of patients

44.7 (21–73 )

11:17

Retrospective

Post-op CT, without classification

100 (24/24)

100 (8/8)

NR

NR

6

Park et al. [79]

2019

South Korea

NR

76

NR

NR

58

62.4 (14.5)

20:38

Retrospective

Modified Upendra

NR

97.4

NR

NR

8

Zhang et al. [80]

2019

China

68

NR

NR

NR

36

6.9 (3.2)

21:15

Retrospective

Smith classification

98.5 (67/68)

NR

NR

NR

8

Wu et al. [9]

2019

China

NR

NR

54

NR

27

38.5 (22–62)

17:10

Prospective

3D model simulation software

NR

NR

100 (54/54)

NR

8

Tian et al. [81]

2019

China

52

12

50

14

64

46.4 (10.7)

40:24

Retrospective

Hlubek et al. classification

96.15 (50/52)

91.67 (11/12)

84 (42/50)

85.7 (12/14)

8

Hur et al. [82]

2019

South Korea

NR

NR

92

NR

48

58.8 (35–80)

30:18

Retrospective

Gertzbein and Robbins

NR

NR

91.3 (82/92)

NR

8

Carl et al. [83]

2019

Germany

NR

NR

26

NR

16

72.7 (24–84)

7:9

Retrospective

Laine et al. classification

NR

NR

96.2 (25/26)

NR

7

Lee et al. [84]

2020

South Korea

26

1

32

1

34 (15 F:19 N)

54.8 (16.7)

18:16

Retrospective

Gertzbein and Robbins

88.5

NR

93.8

NR

9

  1. NR not reported