Robot-Assisted Pedicle Screw Placement Led to Lower Screw Loosening Rate than Fluoroscopy-Guided Technique in Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Single-Center Retrospective Study

Abstract

Robot-assisted pedicle screw placement for spine surgery has become popular in recent years. This study compares clinical, radiographic outcomes and the screw loosening rate between robot-assisted and fluoroscopy-guided pedicle screw placement in patients who underwent transforaminal lumbar interbody fusion (TLIF). We retrospectively examined 108 patients with the degenerative lumbar disease who underwent TLIF. According to whether the robotic system was used, patients were assigned to either the robot-assisted (Ro TLIF, n = 29) or fluoroscopy-guided TLIF (FG TLIF, n = 79) group. Radiographic parameters and patient-reported outcomes, including leg and back pain visual analog scale (VAS) and Oswestry Disability Index (ODI), were assessed. Loosening signs were noted in 48 out of 552 pedicle screws. The screw loosening rate was higher in the FG TLIF (10.2%) than Ro TLIF group (4.3%). A significant correlation was found between screw loosening and age, the number of level(s) fused, and the ratio of the average distance from the pedicle screw to the upper endplate to vertebral body height. VAS-leg, VAS-back, and ODI showed significant improvements in both groups postoperatively (all p < 0.05). These results indicated that robot-assisted pedicle screw placement in TLIF had a lower screw loosening rate and similar patient-reported outcomes compared with the fluoroscopy-guided technique.

Comparison of Robot-Assisted Versus Fluoroscopy-Guided Transforaminal Lumbar Interbody Fusion(TLIF) for Lumbar Degenerative Diseases: A Systematic Review Meta-Analysis of Trails and Observational Studies

“…A nal 21 articles met the inclusion criteria for quantitative analysis. Among them, there were 2 randomized controlled trials (RCTs) [27,29] and 19 observational studies (cohort study) [8,[18][19][20][21][22][23][24][25][26]28,[30][31][32][33][34][35][36][37] . Characteristics of included studies as well as quality assessments are summarized in Table 2, Table 3, and Table 4.…”

“…The overall quality of the included studies was similar among the different CSs and all CSs were considered to have su ciently high quality. Five studies [18,22,28,30,37], scored eight stars, twelve studies [8,19,21,[23][24][25][26]32,[33][34][35][36] , scored seven stars, and two studies [20,31] , scored six stars.…”

“…Wang TY [25] Chen XY [26] Hou HT [32] De Biase G [28] Passias PG [8] Lai YP [30] Sha KA [31] Wang L [36] Li T [37] A Li T [34] B Wang Z [35] Zhao XF [24] Mao JP [22] Jiang SD [23] Lin MC [33] a A maximum of 2 stars can be allotted in this category, one for age, the other for other controlled factors…”

“…Seventeen CSs [8,18,[20][21][22][23][24][25][26]28,30,[32][33][34][35][36][37] and two RCTs [27,29] reported the duration of time, which is shown in Fig 7 . The results of CSs suggest that there is no signi cant difference between RA and FG group (SMD: 0.1111, 95%CI: -0.391-0.6131, z=0.43, I 2 =93%, p=0.6646). The funnel plot demonstrates a symmetrical distribution, and the funnel plot shows minimal changes after trim-and-ll method, indicating this result with a high level of con dence.…”

“…Four CSs [8,20,30,32] and one RCT [27] reported the number of revision case, which is shown in Fig 13 . The results of CSs suggest that there is no signi cant difference in the number of revision case between RA and FG group (RR: 0.4087,95% CI 0.1592-1.0495, z=-1.86, I2=0%, p=0.0629).…”