New navigation techniques demonstrate higher accuracy, lower fluoroscopic frequency and time than 2D fluoroscopy: Study

The researchers note that percutaneous sacroiliac screw fixation is becoming a preferred approach for stabilizing pelvic fragility fractures in elderly patients, helping to preserve mobility and alleviate pain. Traditionally, this procedure has been performed using 2D fluoroscopy. However, newer navigation-assisted techniques have been introduced to potentially enhance precision and safety. The extent to which these advanced methods improve accuracy, reduce radiation exposure, and minimize complications compared to conventional 2D fluoroscopy remains uncertain.

Against the above background, R. A. Haveman, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland, and colleagues aimed to compare percutaneous sacroiliac screw fixation performed with traditional 2D fluoroscopy (2DF) and newer navigation techniques (NNT).

For this purpose, the researchers conducted a systematic review and meta-analysis, searching PubMed, CENTRAL, and Embase for randomized controlled trials and observational studies that compared new navigation techniques with 2D fluoroscopy for percutaneous sacroiliac screw fixation. They pooled effect estimates using a random-effects model and presented the findings as odds ratio, mean difference, and standardized mean difference with a 95% confidence interval.

Key Findings:

• The analysis included 19 studies, with 642 patients in the 2D fluoroscopy group and 663 patients in the new navigation group.
• Accuracy was significantly higher in the new navigation group (OR 2.44), particularly with O-Arm, 3D CT, and robotic navigation.
• On average, accuracy was 82% in the 2D fluoroscopy group and 92% in the new navigation group, showing a significant improvement.
• Fluoroscopy time was significantly reduced in the new navigation group (MD 71.89 seconds).
• The frequency of fluoroscopic imaging was also lower in the new navigation group (MD 17.22 images).
• Complications were acceptably low in both groups, though they were poorly reported in the included studies.

This meta-analysis demonstrated that navigated percutaneous sacroiliac screw fixation offers higher accuracy and reduces fluoroscopic frequency and time compared to conventional 2D fluoroscopy. Among the new navigation techniques, 3D CT and robotic navigation showed even greater advantages. While complication rates remained acceptably low in both groups, data were limited. The authors highlight the need for future studies to determine the most effective navigation technique and assess whether the benefits justify the implementation costs.

Reference:

Haveman, R.A., Buchmann, L., Haefeli, P.C. et al. Accuracy in navigated percutaneous sacroiliac screw fixation: a systematic review and meta-analysis. BMC Surg 25, 89 (2025). https://doi.org/10.1186/s12893-025-02813-z