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The exclusively significant factor was the spinal level of fusion: the higher the level, the more inaccurate the screw position. Overall, 85.9% of the non-navigated screws and 78.5% of all the computer-navigated screws were placed completely intraosseous; adding grade 1 screws (displacement less 2 mm), an acceptable screw position was achieved in 94.6% of the conventionally placed screws and 90.3% of the computer-navigated screws. The strength of this analysis is the huge number of patients and screws all being treated in a single center and the complex mathematical analysis of our data: mixed-effects regression models for a binary outcome were used to address multiple (statistically dependent) measurements within the patients. The limitations are the study's retrospective design, which impairs the data quality and leads to a loss of important information. Furthermore, because oxyclozanide of the explorative nature of our study, the results from the statistical tests have to be interpreted with caution: all significant differences (p?CP-673451 mw senior physician. Although younger surgeons inserted the screws and performed the procedures, the senior physicians advised the younger ones how to do it and, if required, corrected mistakes (for example, the position of the hand while drilling the screw in the pedicle). This effect cannot be determined retrospectively, and therefore it is not astonishing that the experience of the surgeon did not show significant differences regarding the screw placement accuracy. Whether navigation increases placement accuracy is still lively discussed, and the reports Decitabine mouse in the literature are contradictory. Entering the search term ��pedicle screw�� and setting filters to ��meta-analysis,�� the PubMed database delivers five publications (as of January 28, 2013). Setting filters to ��systematic review�� produces a total of 56 articles, of which 7 contribute directly to the topic. Based on 43 publications (28 clinical, 14 cadaveric, and 1 model study), Tian and Xu concluded that navigation systems can increase the accuracy for pedicle screw placement and that the best accuracy can be achieved with 3D-based navigation,18 which is the modality we examined in this project. They did not explicitly differentiate between spinal segments but focused on different navigation modalities (i.e., CT, 2D, and 3D).