The safety and accuracy of robot-assisted pedicle screw internal fixation for spine disease

Abstract

Aims The aim of this study was to systematically compare the safety and accuracy of robot-assisted (RA) technique with conventional freehand with/without fluoroscopy-assisted (CT) pedicle screw insertion for spine disease. Methods A systematic search was performed on PubMed, EMBASE, the Cochrane Library, MEDLINE, China National Knowledge Infrastructure (CNKI), and WANFANG for randomized controlled trials (RCTs) that investigated the safety and accuracy of RA compared with conventional freehand with/without fluoroscopy-assisted pedicle screw insertion for spine disease from 2012 to 2019. This meta-analysis used Mantel-Haenszel or inverse variance method with mixed-effects model for heterogeneity, calculating the odds ratio (OR), mean difference (MD), standardized mean difference (SMD), and 95% confidence intervals (CIs). The results of heterogeneity, subgroup analysis, and risk of bias were analyzed. Results Ten RCTs with 713 patients and 3,331 pedicle screws were included. Compared with CT, the accuracy rate of RA was superior in Grade A with statistical significance and Grade A + B without statistical significance. Compared with CT, the operating time of RA was longer. The difference between RA and CT was statistically significant in radiation dose. Proximal facet joint violation occurred less in RA than in CT. The postoperative Oswestry Disability Index (ODI) of RA was smaller than that of CT, and there were some interesting outcomes in our subgroup analysis. Conclusion RA technique could be viewed as an accurate and safe pedicle screw implantation method compared to CT. A robotic system equipped with optical intraoperative navigation is superior to CT in accuracy. RA pedicle screw insertion can improve accuracy and maintain stability for some challenging areas. Cite this article: Bone Joint Res 2020;9(10):653–666.

Computer-assisted cannulated screw internal fixation versus conventional cannulated screw internal fixation for femoral neck fractures: a systematic review and meta-analysis

“…Although current computer-assisted technology still has the following disadvantages: machinery and equipment are expensive, only a few people can afford the additional costs incurred in using computer-assisted equipment, and specialized learning and training are required [ 27 , 47 ]. At the same time, for safety reasons, orthopedic surgery robots were usually used as auxiliary tools for surgery, and they cannot perform independent drilling operations [ 2 ].…”

“…The current stage is only the initial stage of computer-assisted technology, and computer-assisted devices with more functions are constantly being developed. In the future, they can even be combined with artificial intelligence to perform fully automated screw implantation through deep learning, which will change the future surgery mode and the future surgery trend [ 47 ].…”

A method of 3D‐3D multi‐stage non‐rigid registration of the spine based on binocular structured light

“…The results of the current study indicate that spinal surgery with insertion of pedicle screw has the rate of deviation is as high as 21% to 40% 10–12 . It is the focus of current research to improve the accuracy of insertion in pedicle screw based on the absence of intraoperative radiation 13 …”

Spine Image Guidance and Robotics: Exposure, Education, Training, and the Learning Curve

“…2 Indeed, this technology has consistently been proven to be safe and efficacious in numerous meta-analyses, 3 with specific outcomes including improved accuracy of pedicle screws, fewer proximal facet violations, decreased radiation exposure for surgeons and staff, decreased intraoperative blood loss, shorter postoperative stay, and lower revision rates. [4][5][6][7] However, even given the mounting available evidence that this technology is safe and valuable to surgeons, it has not been widely adopted or become the standard of care. [8][9][10][11] An unmodifiable barrier to universal adoption may be that the medical sciences have relatively longer technology lifecycles, especially compared with computing or automotive vehicle technology.…”