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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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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