Robot‐assisted vs freehand pedicle screw fixation in spine surgery – a systematic review and a meta‐analysis of comparative studies

Yu, Lingjia; Chen, Xi; Margalit, Adam; Peng, Huiming; Qiu, Guixing; Qian, Wenwei

doi:10.1002/rcs.1892

Cited by 69 publications

(75 citation statements)

References 40 publications

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“…The longer surgical duration of the RA group could be attributed to more intraoperative preparation work needed for the robot system. Longer surgical time has also been noted in other robot systems for spine surgery. In the FG group, the intraoperative blood loss was significantly higher than in the RA group.…”

Section: Discussionmentioning

confidence: 66%

Comparison of Superior‐Level Facet Joint Violations Between Robot‐Assisted Percutaneous Pedicle Screw Placement and Conventional Open Fluoroscopic‐Guided Pedicle Screw Placement

Zhang

Tian

et al. 2019

Orthopaedic Surgery

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Objective To compare the superior‐level facet joint violations (FJV) between robot‐assisted (RA) percutaneous pedicle screw placement and conventional open fluoroscopic‐guided (FG) pedicle screw placement in a prospective cohort study. Methods This was a prospective cohort study without randomization. One‐hundred patients scheduled to undergo RA (n = 50) or FG (n = 50) transforaminal lumbar interbody fusion were included from February 2016 to May 2018. The grade of FJV, the distance between pedicle screws and the corresponding proximal facet joint, and intra‐pedicle accuracy of the top screw were evaluated based on postoperative CT scan. Patient demographics, perioperative outcomes, and radiation exposure were recorded and compared. Perioperative outcomes include surgical time, intraoperative blood loss, postoperative length of stay, conversion, and revision surgeries. Results Of the 100 screws in the RA group, 4 violated the proximal facet joint, while 26 of 100 in the FG group had FJV (P = 0.000). In the RA group, 3 and 1 screws were classified as grade 1 and 2, respectively. Of the 26 FJV screws in the FG group, 17 screws were scored as grade 1, 6 screws were grade 2, and 3 screws were grade 3. Significantly more severe FJV were noted in the FG group than in the RA group (P = 0.000). There was a statistically significant difference between RA and FG for overall violation grade (0.05 vs 0.38, P = 0.000). The average distance of pedicle screws from facet joints in the RA group (4.16 ± 2.60 mm) was larger than that in the FG group (1.92 ± 1.55 mm; P = 0.000). For intra‐pedicle accuracy, the rate of perfect screw position was greater in the RA group than in the FG group (85% vs 71%; P = 0.017). No statistically significant difference was found between the clinically acceptable screws between groups (P = 0.279). The radiation dose was higher in the FG group (30.3 ± 11.3 vs 65.3 ± 28.3 μSv; P = 0.000). The operative time in the RA group was significantly longer (184.7 ± 54.3 vs 117.8 ± 36.9 min; P = 0.000). Conclusions Compared to the open FG technique, minimally invasive RA spine surgery was associated with fewer proximal facet joint violations, larger facet to screw distance, and higher intra‐pedicle accuracy.

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Section: Discussionmentioning

confidence: 66%

Comparison of Superior‐Level Facet Joint Violations Between Robot‐Assisted Percutaneous Pedicle Screw Placement and Conventional Open Fluoroscopic‐Guided Pedicle Screw Placement

Zhang

Tian

et al. 2019

Orthopaedic Surgery

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“…The accuracy of screw placement has been widely investigated. In a recent meta-analysis, Yu et al 14 compared 2,062 thoracic and lumbar pedicle screws implanted in 750 patients using RAN or FH technique. They found that only 4.6% of RAN screws breached > 2 mm from the predicted trajectory compared to 16% of screws placed by FH techniques.…”

Section: Discussionmentioning

confidence: 99%

“…RAN has been originally used in spine surgery for the placement of lumbar pedicle screws in spinal fusion. 14 Still, pedicle screw insertion is not the only field of application. Indeed, RAN has been proved to be a safe technique for spinal decompression, oncologic spine surgery, and MISS including cage positioning.…”

Section: Introductionmentioning

confidence: 99%

Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

et al. 2020

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Instrumented spine procedures have been performed for decades to treat a wide variety of spinal disorders. New technologies have been employed to obtain a high degree of precision, to minimize risks of damage to neurovascular structures and to diminish harmful exposure of patients and the operative team to ionizing radiations. Robotic spine surgery comprehends 3 major categories: telesurgical robotic systems, robotic-assisted navigation (RAN) and virtual augmented reality (AR) systems, including AR and virtual reality. Telesurgical systems encompass devices that can be operated from a remote command station, allowing to perform surgery via instruments being manipulated by the robot. On the other hand, RAN technologies are characterized by the robotic guidance of surgeon-operated instruments based on real-time imaging. Virtual AR systems are able to show images directly on special visors and screens allowing the surgeon to visualize information about the patient and the procedure (i.e., anatomical landmarks, screw direction and inclination, distance from neurological and vascular structures etc.). The aim of this review is to focus on the current state of the art of robotics and AR in spine surgery and perspectives of these emerging technologies that hold promises for future applications.

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“…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. Also in this study, robot‐assistance was associated with a longer operative time but had a shorter radiation exposure time.…”

Section: Discussionmentioning

confidence: 99%

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

Spyrantis

Cattani

Seifert

et al. 2019

Robotics Computer Surgery

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Objective Feasibility of robotic minimal invasive pedicle screw (PS) placement in the thoracolumbar spine using preoperative three‐dimensional (3D) fluoroscopy without computed tomography (CT). Methods In three cadavers, 12 pedicle screws were implanted in thoracolumbar segments with the robotic surgery assistant. 3D fluoroscopy was performed for preoperative referencing, planning, and identification of postoperative screw position. The radiation exposure of fluoroscopy and a CT scanner was compared, measuring the CT dose index (CTDIw). Results Pedicle screw positioning was graded according to the classification of Gertzbein and Robbins: 11 of 12 pedicle screws showed optimal transpedicular position (grade 1) and one was positioned less than 2 mm outside (grade 2). No major deviations were observed. Referencing with 3D fluoroscopy resulted in a CTDIw reduction of 84% in the cervical and 33% in the lumbar spine. Conclusions Robot‐guided PS placement, using 3D fluoroscopy for referencing, is a reliable tool for minimally invasive PS implantation; radiation exposure can be reduced.

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Robot‐assisted vs freehand pedicle screw fixation in spine surgery – a systematic review and a meta‐analysis of comparative studies

Cited by 69 publications

References 40 publications

Comparison of Superior‐Level Facet Joint Violations Between Robot‐Assisted Percutaneous Pedicle Screw Placement and Conventional Open Fluoroscopic‐Guided Pedicle Screw Placement

Comparison of Superior‐Level Facet Joint Violations Between Robot‐Assisted Percutaneous Pedicle Screw Placement and Conventional Open Fluoroscopic‐Guided Pedicle Screw Placement

Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

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

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