Comparison of Accuracy and Clinical Outcomes of Robot-Assisted Versus Fluoroscopy-Guided Pedicle Screw Placement in Posterior Cervical Surgery

Abstract

Study Design: This was a prospective controlled study. Objective: To compare the accuracy and clinical outcomes of robot-assisted (RA) and fluoroscopy-guided (FG) pedicle screw placement in posterior cervical surgery. Methods: This study included 58 patients. The primary outcome measures were the 1-time success rate and the accuracy of pedicle screw placement according to the Gertzbein-Robbins scales. The secondary outcome measures, including the operative time, intraoperative blood loss, hospital stay, cumulative radiation time, radiation dose, intraoperative advent events, and postoperative complications, were recorded and analyzed. The Japanese Orthopedics Association (JOA) scores and Neck Disability Index (NDI) were used to assess the neurological function of patients before and at 3 and 6 months after surgery. Results: The rate of grade A was significantly higher in the RA group than in the FG group (90.6% and 71.1%; P < .001). The clinically acceptable accuracy was 97.2% in the RA group and 90.7% in the FG group ( P = .009). Moreover, the 1-time success rate was significantly higher in the RA group than in the FG group. The RA group had less radiation time ( P < .001) and less radiation dose ( P = .002) but longer operative time ( P = .001). There were no significant differences in terms of intraoperative blood loss, hospital stay, intraoperative adverse events, postoperative complications, JOA scores, and NDI scores at each follow-up time point between the 2 groups. Conclusions: The RA technique achieved higher accuracy and 1-time success rate of pedicle screw placement in posterior cervical surgery while achieving comparable clinical outcomes.

Robot-assisted minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a retrospective matched-control analysis for clinical and quality-of-life outcomes

“…In this retrospective cohort study, patients in the RA MIS-TLIF group had high one-time success rate of screw placement as well as higher screw accuracy, which was in accordance with some previous literature using RA techniques [18,27,31,32]. Roser et al found a 99% accuracy rate of lumbosacral pedicle instrumentation using the SpineAssist robot compared with 98% utilizing fluoroscopy guided, and 92% using navigation techniques [33].…”

“…The TiRobot system that we used was a multi-indication, real-time, image-guided orthopaedic surgical robot approved by China in 2016. So far, several literature have been published to evaluate the accuracy and clinical outcomes with utilization of orthopaedic robot in posterior cervical surgery and thoracolumbar surgery [14,[27][28][29]. At present, there is an increasing number of studies focusing on the combination of robot with MIS-TLIF technique in the treatment of lumbar degenerative disease [16][17][18][19]26,30].…”

Robotics in Cervical Spine Surgery: Feasibility and Safety of Posterior Screw Placement

“…They found that the RA techniques showed superiority to FH methods in accuracy and clinical outcomes in cervical spine surgery. This finding is consistent with the conclusions obtained from the comparative studies performed by Su et al, 14 Lyu et al, 15 and Zhan et al 16 However, the rates of cervical screw placement accuracy with RA methods varied widely ranging from 66.7% to 91.4% in the published literatures of comparative studies and case series. [13][14][15][16][17][18][19] In addition, the application of RA system on cervical spine surgery is still in its early developmental stage, and whether the RA techniques are safe and accurate in cervical screw placement remains controversial.…”

Comparison of accuracy and safety between second-generation TiRobot-assisted and free-hand thoracolumbar pedicle screw placement

“…Panchmatia et al [ 20 ] reported that 40% of screws inserted using conventional fluoroscopic guidance breached compared with 2.5% of screws inserted with robot assistance. Su et al [ 21 ] found that the RA technique achieved higher accuracy and one-time success rate of pedicle screw placement in posterior cervical surgery. Hyun et al [ 22 ] also suggested superiority of the RA technique, with higher precision rates using robotic guidance.…”