Safety and Accuracy of Robot-Assisted Placement of Pedicle Screws Compared to Conventional Free-Hand Technique: A Systematic Review and Meta-Analysis.
Spine J. 2020 Sep 22;:
Authors: Fatima N, Massaad E, Hadzipasic M, Shankar GM, Shin JH
BACKGROUND CONTEXT: The introduction and integration of robot technology into modern spine surgery provides surgeons with millimeter accuracy for pedicle screw placement. Coupled with computer-based navigation platforms, robot-assisted spine surgery utilizes augmented reality to potentially improve the safety profile of instrumentation.
PURPOSE: In this study, the authors seek to determine the safety and efficacy of robotic-assisted pedicle screw placement compared to conventional free-hand (FH) technique.
STUDY DESIGN/SETTING: We conducted a systematic review of the electronic databases using different MeSH terms from 1980 to 2020.
OUTCOME MEASURES: The present study measures pedicle screw accuracy, complication rates, proximal-facet joint violation, intra-operative radiation time, radiation dosage, and length of surgery.
RESULTS: A total of 1,525 patients (7,379 pedicle screws) from 19 studies with 777 patients (51.0% with 3,684 pedicle screws) in the robotic-assisted group were included. Perfect pedicle screw accuracy, as categorized by Gerztbein-Robbin Grade A, was significantly superior with robotic-assisted surgery compared to FH-technique (OR: 1.68, 95%CI:1.20-2.35; p=0.003). Similarly, clinically acceptable pedicle screw accuracy (Grade A+B) was significantly higher with robotic-assisted surgery versus FH-technique (OR: 1.54, 95%CI:1.01-2.37; p=0.05). Furthermore, the complication rates and proximal-facet joint violation were 69% (OR: 0.31, 95%CI:0.20-0.48; p<0.00001) and 92% less likely (OR: 0.08, 95%CI:0.03-0.20; p<0.00001) with robotic-assisted surgery versus FH-group. Robotic-assisted pedicle screw implantation significantly reduced intra-operative radiation time (MD: -5.30,95%CI:-6.83-3.76; p<0.00001) and radiation dosage (MD: -3.70, 95%CI:-4.80-2.60; p<0.00001) compared to the conventional FH-group. However, the length of surgery was significantly higher with robotic-assisted surgery (MD: 22.70, 95%CI:6.57-38.83; p=0.006) compared to the FH-group.
CONCLUSION: This meta-analysis corroborates the accuracy of robot-assisted pedicle screw placement.
PMID: 32976997 [PubMed – as supplied by publisher]