Accuracy of Pedicle Screw Placement and Clinical Outcomes of Robot-assisted Technique Versus Conventional Freehand Technique in Spine Surgery From Nine Randomized Controlled Trials

Abstract

Study Design. A meta-analysis. Objective. To investigate whether robot-assisted techniques are superior to conventional techniques in terms of the accuracy of pedicle screw placement and clinical indexes. Summary of Background Data. Robot-assisted techniques are increasingly applied to spine surgery to reduce the rate of screw misplacement. However, controversy about the superiority of robot-assisted techniques over conventional freehand techniques remains. Methods. We conducted a comprehensive search of PubMed, EMBASE, and Cochrane Library for potentially eligible articles. The outcomes were evaluated in terms of risk ratio (RR) or standardized mean difference and the associated 95% confidence intervals (CIs). Meta-analysis was performed using the RevMan 5.3 software and subgroup analyses were performed based on the robot type for the accuracy of pedicle screw placement. Results. Nine randomized controlled trials with 696 patients were included in this meta-analysis. The results demonstrated that the robot-assisted technique was more accurate in pedicle screw placement than the freehand technique. Subgroup analyses showed that the TINAVI robot-assisted technique was more accurate in screw positions Grade A (RR, 1.10; 95% CI, 1.06–1.14), Grade B (RR, 0.46; 95% CI, 0.28–0.75), and Grades C + D + E (RR, 0.21; 95% CI, 0.09–0.45) than the freehand technique, whereas the Renaissance robot-assisted technique showed the same accuracy as the freehand technique in screw positions Grade A, Grade B, and Grades C + D + E. Furthermore, the robot-assisted techniques showed equivalent postoperative stay, visual analogue scale scores, and Oswestry disability index scores to those of the freehand technique and shorter intraoperative radiation exposure time, fewer radiation dose and proximal facet violations but longer surgical time than the freehand technique. Conclusion. The robot-assisted technique is more accurate in pedicle screw placement than the freehand technique. And TINAVI robot-assisted pedicle screw placement is a more accurate alternative to conventional techniques and the Renaissance robot-assisted procedure. Level of Evidence: 1

A novel fluoroscopy‐based robot system for pedicle screw fixation surgery

“…Through the analysis of 9 randomized controlled trials, Li et al concluded that the robot-assisted technique was more accurate in pedicle screw placement than the freehand technique. 11 In our study, the screw placement with 100% accuracy was achieved with our robot system. While in freehand group, the accuracy was not high (73.9%), partially because the operators were junior doctors after training for MIS surgery.…”

“…3,[5][6][7][8] To improve the accuracy and safety of pedicle screw placement, computer and robot-assisted technique have been gradually applied in spinal surgery for better clinical outcome since 1995. 9 Studies have shown that robot-assisted technique contributed to better accuracy in positioning [10][11][12] and less invasiveness, as well as less radiation damage 13,14 compared with the conventional freehand screw placement. Currently, several spinal robotic systems have been reported to be applicable for spinal procedures, including SpineAssist, MazorX, ROSA Spine, TianJi Robot 15 and so.…”

Telerobotic Spinal Surgery Based on 5G Network: The First 12 Cases

“…According to the previous study, by using the TiRobot system, 95.3% of pedicle screws were classified as grade A in Gertzbein-Robbins criteria, compared with 86.1% using freehand method. 12 According to meta-analysis of Li et al, 26 the accuracy of robot-assisted pedicle screw placement was significantly higher than the freehand method.…”

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

“…Gao et al performed a metaanalysis including six studies involving 158 patients (688 pedicle screws) in a robot-assisted group and 148 patients (672 pedicle screws) in a freehand group, and showed that the robot-assisted technique was associated with equivalent accuracy rate of pedicle screw implantation, fewer proximal facet joint violations, and less intraoperative radiation exposure, but longer surgical duration than that with the freehand technique [12]. However, a recent meta-analysis of nine randomized controlled trials with 696 patients, evaluating the accuracy of pedicle screw placement with robot-assisted techniques versus conventional freehand techniques, showed a signi cant increase in accuracy when using the robotassisted technique [13]. Spinal robots can provide precise guidance to the areas that are appropriately imaged and registered.…”

“…Recently, robotics in spinal surgery were predominantly designed as navigational devices for pedicle screw insertion, such as the Mazor X (Medtronic and Mazor Robotics, Medtronic, Minneapolis, MN, USA), ROSA (Med Tech Surgical, Inc., Newark, NJ, USA), and Excelsius GPS (Globus Medical, Inc., Audubon, PA, USA) [9][10][11]. Multiple studies have reported early experiences with robot-assisted pedicle screw placement and the outcomes are promising [12][13][14]. Increasingly, researchers have already focused on the combination of MIS and robotic navigation to improve the e ciency and accuracy of spinal surgeries [15,16].…”