Robot-assisted and fluoroscopy-guided pedicle screw placement: A meta-analysis / 中国组织工程研究

ABSTRACT

BACKGROUND: Computer navigation system and orthopedic surgery robot have been developed rapidly in spine surgery in recent years, but the operation effect of computer navigation or navigation robot is still questioned. OBJECTIVE: To compare the difference in robot-assisted and fluoroscopy-guided pedicle screw placement. METHODS: The study included clinical trials published in and outside China from August 2008 to August 2019. The retrieval was performed in the online databases including Embase, PubMed, CNKI, and Wanfang Data. Key words in Chinese were robot assisted, fluoroscopy guided, pedicle screw, pedicle nail, pedicle screw rod, pedicle internal fixation. Search strategy was pedicle screw AND robot assisted OR fluoroscopy guided. Key words in English were Robot assisted, Fluoroscopy guided, Pedicle screw, Pedicle stick, Pedicle screw fixation. Search strategy was “Pedicle screw” OR “Pedicle stick” OR “Pedicle screw fixation” AND “Fluoroscopy guided” OR “Robot assisted”. After data extraction, statistical software Review Manager 5.3 was used for data analysis. RESULTS AND CONCLUSION: (1) Based on the above search strategy, 357 studies were retrieved. A total of 19 trials were included, containing 17 English studies and 2 Chinese studies. (2) Meta-analysis results displayed that the accuracy of placement of the robot-assisted group was superior to that of the fluoroscopy-guided group [95%CI(1.82, 2.52), P < 0.001]. Number of surgical complications [95%CI(0.25, 0.69), P=0.0006] and revision number [95%CI(0.23, 0.71), P=0.002] were less in the robot-assisted group than in the fluoroscopy-guided group. (3) When evaluating pedicle screw placement, robot-assisted has higher pedicle screw placement accuracy, fewer complications and fewer revisions, and is superior to traditional fluoroscopy-guided technique in accuracy and safety. Considering the expensive price and complex operation steps of navigation robot technology, the selection of specific nail placement method should still follow the principle of individualized treatment.