Effect of Intraoperative Image-Guided Spinal Navigation Technologies on Endoscopic Lumbar Spine Surgery: A Systematic Review and Meta-Analysis

Study Design Meta-Analysis. Objectives Intraoperative image-guided spinal navigation provides real-time imaging during surgery and can enhance pathology localization, optimize working channel placement, and facilitate the learning process of Endoscopic lumbar spine surgery (ELSS). This meta-analysis examined whether intraoperative image-guided spinal navigation offers perioperative and clinical advantages in ELSS compared with conventional C-arm fluoroscopy. Methods We systematically searched PubMed, Europe PMC, Scopus, Cochrane Library, and ClinicalTrials.gov for studies comparing the perioperative and clinical outcome of intraoperative image-guided spinal navigation with conventional C-arm fluoroscopy in ELSS. Results were summarized using the mean difference (MD) or standardized mean difference (SMD) with accompanying 95% confidence intervals. Results A total of 19 studies involving 1390 patients were included for meta-analysis. Intraoperative image-guided spinal navigation in ELSS was significantly associated with a shorter total operation time (MD = −11.18 min, P < 0.01), fewer puncture attempts (MD = −2.94 times, P < .01), shorter cannulation time (MD = −12.59 min, P < 0.01), lower fluoroscopy use frequency (MD = −14.75 times, P < 0.01), lower radiation exposure (SMD = −4.18, P < 0.01), and shorter hospital stay (MD = −0.44 days, P = 0.03) compared with C-arm fluoroscopy. No significant differences in back Visual Analog Scale (VAS) scores, leg VAS scores, or Oswestry Disability Index scores were observed at up to 1 year of follow-up. Conclusion Intraoperative image-guided spinal navigation in ELSS significantly affects perioperative outcomes. However, clinical outcomes are not affected by the type of navigation. Further research is required to evaluate its cost-effectiveness across diverse health-care systems.