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Review
. 2020 Jul;8(13):824.
doi: 10.21037/atm-20-1106.

Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials

Yu-Ning Peng  1 , Li-Cheng Tsai  1 , Horng-Chaung Hsu  2 , Chia-Hung Kao  3   4   5   6
Affiliations
Review

Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials

Yu-Ning Peng et al. Ann Transl Med. 2020 Jul.

Abstract

This systematic review and meta-analysis investigated differences in accuracy, operation time, and radiation exposure time between robot-assisted and freehand techniques for pedicle screw insertion. Two investigators independently searched for articles on randomized controlled trials (RCTs) published from 2012 to 2019. The final meta-analysis included seven RCTs. We compared the accuracy of pedicle screw placement, operation time, and radiation exposure time between robot-assisted and conventional freehand groups. Seven RCTs included 540 patients and placement of 2,476 pedicle screws, of which 1,220 were inserted using the robot-assisted technique and 1,256 were inserted using the conventional freehand technique. The pedicle screw positions were classified using the Gertzbein and Robbins classification (grade A-E). The combined results of Grade A [odds ratio (OR) =1.68; 95% confidence intervals (CI): 0.82-3.44; P=0.16), Grade A+B (OR =1.70; 95% CI: 0.47-6.13; P=0.42), and Grade C+D+E (OR =0.59; 95% CI: 0.16-2.12; P=0.42) for the accuracy rate revealed no significant difference between the two groups. Subgroup analysis results revealed that the TiRobot-assisted technique presented a significantly improved pedicle screw insertion accuracy rate compared with that of the conventional freehand technique, based on Grade A, Grade A+B, and Grade C+D+E classifications. The SpineAssist-assisted technique presented an inferior pedicle screw insertion accuracy rate compared with that of the conventional freehand technique, based on Grade A, Grade A+B, and Grade C+D+E classifications. No difference between the Renaissance-assisted and conventional freehand techniques was noted for pedicle screw insertion accuracy rates, based on both Grade A (OR =1.58; 95% CI: 0.85-2.96; P=0.15), Grade A+B (OR =2.20; 95% CI: 0.39-12.43; P=0.37), and Grade C+D+E (OR =0.45; 95% CI: 0.08-2.56; P=0.37) classifications. Regarding operation time, robot-assisted surgery had significantly longer operation time than conventional freehand surgery. The robot-assisted group had significantly shorter radiation exposure time. Regarding the pedicle screw insertion accuracy rate, the TiRobot-assisted technique was superior, the SpineAssist-assisted technique was inferior, and Renaissance was similar to the conventional freehand technique.

Keywords: Robot-assisted; SpineAssist-assisted technique; TiRobot-assisted technique; radiation exposure; randomized controlled trials (RCTs).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-1106). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
PRISMA flow chart depicting literature search and selection process.
Figure 2
Figure 2
Risk of bias graph.
Figure 3
Figure 3
Risk of bias summary.
Figure 4
Figure 4
Pedicle screw insertion accuracy (Grade A): robot-assisted technique versus freehand technique.
Figure 5
Figure 5
The comparison of pedicle screw insertion accuracy based on the Gertzbein–Robbins Classification Grade A+B (0 and <2 mm).
Figure 6
Figure 6
The comparison of pedicle screw insertion accuracy based on the Gertzbein–Robbins Classification Grade C+D+E.
Figure 7
Figure 7
Operation time (min): robot-assisted versus freehand.
Figure 8
Figure 8
Radiation exposure time (s): robot-assisted versus freehand.
See this image and copyright information in PMC

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