Nida Fatima1, Elie Massaad1, Muhamed Hadzipasic1, Ganesh M Shankar1, John H Shin2. 1. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 2. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: Shin.john@mgh.harvard.edu.
Abstract
BACKGROUND CONTEXT: The introduction and integration of robot technology into modern spine surgery provides surgeons with millimeter accuracy for pedicle screw placement. Coupled with computer-based navigation platforms, robot-assisted spine surgery utilizes augmented reality to potentially improve the safety profile of instrumentation. PURPOSE: In this study, the authors seek to determine the safety and efficacy of robotic-assisted pedicle screw placement compared to conventional free-hand (FH) technique. STUDY DESIGN/ SETTING: We conducted a systematic review of the electronic databases using different MeSH terms from 1980 to 2020. OUTCOME MEASURES: The present study measures pedicle screw accuracy, complication rates, proximal-facet joint violation, intraoperative radiation time, radiation dosage, and length of surgery. RESULTS: A total of 1,525 patients (7,379 pedicle screws) from 19 studies with 777 patients (51.0% with 3,684 pedicle screws) in the robotic-assisted group were included. Perfect pedicle screw accuracy, as categorized by Gerztbein-Robbin Grade A, was significantly superior with robotic-assisted surgery compared to FH-technique (Odds ratio [OR]: 1.68, 95% confidence interval [CI]: 1.20-2.35; p=.003). Similarly, clinically acceptable pedicle screw accuracy (Grade A+B) was significantly higher with robotic-assisted surgery versus FH-technique (OR: 1.54, 95% CI: 1.01-2.37; p=.05). Furthermore, the complication rates and proximal-facet joint violation were 69% (OR: 0.31, 95% CI: 0.20-0.48; p<.00001) and 92% less likely (OR: 0.08, 95% CI: 0.03-0.20; p<.00001) with robotic-assisted surgery versus FH-group. Robotic-assisted pedicle screw implantation significantly reduced intraoperative radiation time (MD: -5.30, 95% CI: -6.83-3.76; p<.00001) and radiation dosage (MD: -3.70, 95% CI: -4.80-2.60; p<.00001) compared to the conventional FH-group. However, the length of surgery was significantly higher with robotic-assisted surgery (MD: 22.70, 95% CI: 6.57-38.83; p=.006) compared to the FH-group. CONCLUSION: This meta-analysis corroborates the accuracy of robot-assisted pedicle screw placement.
BACKGROUND CONTEXT: The introduction and integration of robot technology into modern spine surgery provides surgeons with millimeter accuracy for pedicle screw placement. Coupled with computer-based navigation platforms, robot-assisted spine surgery utilizes augmented reality to potentially improve the safety profile of instrumentation. PURPOSE: In this study, the authors seek to determine the safety and efficacy of robotic-assisted pedicle screw placement compared to conventional free-hand (FH) technique. STUDY DESIGN/ SETTING: We conducted a systematic review of the electronic databases using different MeSH terms from 1980 to 2020. OUTCOME MEASURES: The present study measures pedicle screw accuracy, complication rates, proximal-facet joint violation, intraoperative radiation time, radiation dosage, and length of surgery. RESULTS: A total of 1,525 patients (7,379 pedicle screws) from 19 studies with 777 patients (51.0% with 3,684 pedicle screws) in the robotic-assisted group were included. Perfect pedicle screw accuracy, as categorized by Gerztbein-Robbin Grade A, was significantly superior with robotic-assisted surgery compared to FH-technique (Odds ratio [OR]: 1.68, 95% confidence interval [CI]: 1.20-2.35; p=.003). Similarly, clinically acceptable pedicle screw accuracy (Grade A+B) was significantly higher with robotic-assisted surgery versus FH-technique (OR: 1.54, 95% CI: 1.01-2.37; p=.05). Furthermore, the complication rates and proximal-facet joint violation were 69% (OR: 0.31, 95% CI: 0.20-0.48; p<.00001) and 92% less likely (OR: 0.08, 95% CI: 0.03-0.20; p<.00001) with robotic-assisted surgery versus FH-group. Robotic-assisted pedicle screw implantation significantly reduced intraoperative radiation time (MD: -5.30, 95% CI: -6.83-3.76; p<.00001) and radiation dosage (MD: -3.70, 95% CI: -4.80-2.60; p<.00001) compared to the conventional FH-group. However, the length of surgery was significantly higher with robotic-assisted surgery (MD: 22.70, 95% CI: 6.57-38.83; p=.006) compared to the FH-group. CONCLUSION: This meta-analysis corroborates the accuracy of robot-assisted pedicle screw placement.
Authors: Kazim H Narsinh; Ricardo Paez; Kerstin Mueller; M Travis Caton; Amanda Baker; Randall T Higashida; Van V Halbach; Christopher F Dowd; Matthew R Amans; Steven W Hetts; Alexander M Norbash; Daniel L Cooke Journal: Neuroradiol J Date: 2021-08-16
Authors: Setefilla Luengo-Matos; Luis María Sánchez-Gómez; Ana Isabel Hijas-Gómez; Esther Elena García-Carpintero; Rafael Ballesteros-Massó; Mar Polo-deSantos Journal: J Orthop Traumatol Date: 2022-10-15
Authors: Vittorio Stumpo; Victor E Staartjes; Anita M Klukowska; Aida Kafai Golahmadi; Pravesh S Gadjradj; Marc L Schröder; Anand Veeravagu; Martin N Stienen; Carlo Serra; Luca Regli Journal: Neurosurg Rev Date: 2020-11-30 Impact factor: 3.042