Comparison of Cranial Facet Joint Violation Rate Between Percutaneous and Open Pedicle Screw Placement: A Systematic Review and Meta-Analysis

Percutaneous and open pedicle screw placements have been widely used in lumbar fusion surgery. However, there are conflicting reports of cranial facet joint violation rate for the 2 techniques. To better determine the rate of cranial facet joint violation, a systematic review and meta-analysis was performed in the present study. We searched the established electronic literature databases including MEDLINE, EMBASE, World of Science, and the Cochrane Central Register of Controlled Trials databases for trials involving the 2 pedicle screw placement techniques. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Four comparative trials with a cumulative sample size of 881 patients and 1755 cranial pedicle screws were identified and analyzed. The results showed that cranial facet joint violation rate was 18.18% (154/847) in percutaneous group and 18.72% (170/908) in open group. The pooled data revealed that there was no significant difference in the violation rate (OR 0.75, 95% CI 0.24–2.30, P = 0.62). In addition, there was also no significant difference for the rate of severe violation between the 2 techniques (OR 1.20, 95% CI 0.55–2.62, P = 0.64, random effect model). Based on the current data, the meta-analysis shows that similar cranial facet joint violation rate occurs during the percutaneous and open pedicle screw placement techniques. In addition, taking the limitations of this study into consideration, it was still not appropriate to draw such a strong conclusion. More well-designed prospective randomized controlled trials are needed to assess violation rate for the 2 techniques in the future.