Navigation and 3D-imaging in pelvic ring surgery: a systematic review of prospective comparative studies

Abstract

Background: Few literature reviews have been published focusing on navigation, robotic or pre-operative planning using 3D-imaging technology (3D-printing, 3D-planning). To our knowledge, no reviews have been performed to assess and compare all these modalities together versus control groups (conventional fluoroscopy) through high Randomized Control Trials (RCTs) and Prospective Control Studies (PCSs). The aim of this study was to assess and compare 3D-imaging technologies from pre-operative planning to per-operative navigation and robotic in the management of pelvic ring fractures through high level studies.

Methods: A literature search was performed using PubMed, the Cochrane library and Google scholar using keywords up to December 2023. Only prospective comparative studies (RCT and PCS) were included. A total of 341 articles were identified, 39 articles were selected for full-text analysis leaving 7 articles included in this literature systematic review.

Results: A trend towards improved precision in screw placement and reduction of radiation exposure without consequences in term of functional outcomes have been identified. No conclusions can be extrapolated regarding operative time and blood loss except for robotic which improve these parameters because robotic arm assistance help surgeons to correctly follow the planning based on 2D-fluoroscopy. Surgery duration and radiation dose are significantly reduced with robotic-arm assistance for the same reasons. With navigation the results have to be nuanced according to the experience of the surgical team. Interest of navigation is emphasized in sacral dysmorphism in comparison with conventional fluoroscopy. This highlights the benefits of navigation for ilio-sacral screw placement in difficult cases and less experimented teams.

Conclusion: High level studies which assess and compare 3D-imaging technologies from pre-operative planning to per-operative navigation and robotic in the management of pelvic ring fractures are low. To date and according to the present high level literature, navigation and 3D-technologies in pelvic ring surgery should be recommended for difficult cases.

Level of evidence, ii: Systematic review of Level II studies.

Keywords: 3D-imaging; Navigation; Pelvic ring surgery; Prospective comparative studies; Review; Robotic.