Robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis of randomized controlled trials

Abstract

The robot-assisted technique was associated with equivalent accuracy rate of pedicle screw implantation, fewer proximal facet joint violation, less intraoperative radiation exposure but longer surgical duration than freehand technique. Powerful evidence relies on more randomized controlled trials with high quality and larger sample size in the future.

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

“…Therefore, robot-assisted techniques are designed to help spinal surgeons with more precision and convenience of pedicle screw placement [14][15][16]. 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].…”

“…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].…”

Minimally invasive percutaneous robotic thoracolumbar pedicle screw implantation combined with three‐dimensional fluoroscopy can reduce radiation: A cadaver and phantom study

“…They showed no difference in the accuracy between robot‐assisted and conventional freehand PS placement. A meta‐analysis from Gao et al of six randomized controlled trials, involving 688 PSs in 158 patients in the robot‐assisted group and 672 PSs in 148 patients in the freehand group, demonstrated equal accuracy, less radiation exposure during surgery, but a longer surgical duration of the robot‐assisted PSs. Yu et al analysed three randomized controlled trials and found no significant differences between robot‐assisted and fluoroscopy‐guided PS implantation regarding accuracy.…”

Minimally invasive versus conventional fixation of tracer in robot-assisted pedicle screw insertion surgery: a randomized control trial

“…Pedicle screw fixation plays an important role in reconstruction procedures for spinal stability. Given the complex morphology and variability of the pedicle, screws penetrating it may injure surrounding tissues, thus resulting in severe complications in conventional spine surgery procedures, especially those involving freehand pedicle screw insertion [1][2][3][4][5]. To improve the rate of successful screw placement and reduce the complications, a robotic system for spinal surgery has been recently developed.…”