Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement

Abstract

Robotic-guided and percutaneous pedicle screw placement are emerging technologies. We here report a retrospective cohort analysis comparing conventional open to open robotic-guided and percutaneous robotic-guided pedicle screw placement. 112 patient records and CT scans were analyzed concerning the intraoperative and perioperative course. 35 patients underwent percutaneous, 20 open robotic-guided and 57 open conventional pedicle screw placement. 94.5% of robot-assisted and 91.4% of conventionally placed screws were found to be accurate. Percutaneous robotic and open robotic-guided subgroups did not differ obviously. Average X-ray exposure per screw was 34 s in robotic-guided compared to 77 s in conventional cases. Subgroup analysis indicates that percutaneously operated patients required less opioids, had a shorter hospitalization and lower rate of adverse events in the perioperative period. The use of robotic guidance significantly increased accuracy of screw positioning while reducing the X-ray exposure. Patients seem to have a better perioperative course following percutaneous procedures.

Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review

“…The duration of surgery in the robot-assisted and fluoroscopy-guided groups was not reported as being significantly different in any of the three studies that analyzed this data [9,11,17].…”

“…Full text screening of the remaining 22 articles led to the exclusion of a further 17 articles. In all, 5 articles were identified that satisfied our inclusion criteria, comprising two randomized controlled trials (of which one reported preliminary findings), one prospective cohort, one retrospective cohort, and one cadaveric study (Table 1) [9,11,17,18,20]. A total of 1,308 pedicle screws were reported-729 using robot-assistance, and 579 using fluoroscopy-guidance.…”

“…In all, 94.1 % (686/729) of pedicle screws placed with robotassistance were satisfactory, compared with 92.7 % (537/ 579) of pedicle screws placed with fluoroscopy-guidance. Ringel et al [17] favored fluoroscopy-guidance (p = 0.019), and the remaining studies supported robotassistance (albeit often not reaching statistical significance) [9,11,18,20]. A forest plot summarizing the odds ratios of the included studies is illustrated in Fig.…”

“…Kantelhardt et al and Lieberman et al [9,11] reported radiation exposure to be significantly less during robot-assisted pedicle screw insertion compared to fluoroscopy-guided procedures, while Ringel et al and Schizas et al [17,20] observed no significant difference in radiation exposure. Roser et al [18] did not perform a statistical comparison on their preliminary findings, but a trend towards reduced radiation exposure in the robot-assisted group was observed.…”

“…No participant withdrawal or loss to follow-up was reported. The quality of the studies by Schizas et al and Kantelhardt et al were evaluated using the MINORS system [9,20,23]. Neither study prospectively calculated the study size.…”