Efficacy and safety of robotic spine surgery: systematic review and meta-analysis.

BACKGROUND: Robotic surgery (RS) may offer benefits compared with freehand/conventional surgery (FS) in the treatment of patients with spinal disease. The aim of this study was to evaluate the efficacy and safety of RS versus FS in spinal fusion. METHODS: A systematic review and meta-analysis was performed. Data analysis and risk of bias assessment were analysed using REVMAN V5.3. RESULTS: We found 11 randomised clinical trials involving 817 patients (FS: 408, RS: 409). The main diagnosis was degenerative spine disease. SpineAssist, Renaissance (Mazor Robotics), Tianji Robot and TiRobot robots (TINAVI Medical Technologies) were used. Pedicle screw placement within the safety zone (grades A + B according to the Gertzbein and Robbins scale) ranged from 93% to 100% in FS versus 85-100% in RS (relative risk 1.01, 95% CI 1.00-1.03, p = 0.14). Regarding intervention time, the meta-analysis showed a mean difference (MD) of 6.45 min (95% CI -13.59 to 26.49, p = 0.53). Mean hospital stay was MD of -0.36 days (95% CI -1.03 to 0.31, p = 0.30) with no differences between groups. Contradictory results were found regarding fluoroscopy time, although there seems to be a lower radiation dose in RS versus FS (p < 0.05). Regarding safety, the studies included surgical revision frequency. CONCLUSIONS: No conclusive results were found suggesting that there are benefits in using RS over FS for spinal fusion. Further research with adequate patient selection, robot type and quality-of-life variables is needed. LEVEL OF EVIDENCE: level 1.

Mammography use and factors associated with its use after the introduction of breast cancer screening programmes in Spain.

The aim of this study was to measure the use of mammography and the factors associated with testing among Spanish women, after the introduction of screening programmes in Spain. We conducted a cross-sectional population survey of a representative sample of women aged 40-70 (2409 women). Data collection took place in October 2000, using a questionnaire addressing the dependent variable (mammography use) and the independent variables (socio-demographic and socio-health factors, and women's knowledge and attitudes). Mammography use was defined as having received at least one screening test in the previous 2 years. Data analysis consisted of univariate and multivariate analyses. 48.1% (95% confidence interval (CI) 46.0-50.2) of women had received screening mammography. The main factors associated with testing were: mammography invitation from the screening programme (odds ratio (OR) 4.81; 95% CI 3.85-6.01); gynaecologist visit (OR 4.32; 95% CI 3.45-5.41); and intention to have a mammogram (OR 2.94; 95% CI 2.00-4.32). Other test-related factors were: not rejecting test for discomfort or fear of cancer; mammography perceived as necessary; age 56-65; upper/upper-middle socio-economic status. In conclusion, after the introduction of screening programmes, almost half of Spanish women aged 40-70 had received mammography. Invitation to screening, gynaecologist visit and women's attitudes are the main reasons for undergoing testing. Women over 65 years of age and/or those in a lower socio-economic level warrant special attention.

Diferencias en los factores relacionados con el uso de la mamografía en las mujeres españolas en los años 1994 y 2000 (*) / Differences in the factors related to the use of mammograms among spanish women in 1994 and 2000

Fundamento: La mamografía de cribado es el procedimientomás efectivo para la detección precoz del cáncer de mama. El objetivodel presente estudio es conocer las diferencias en los factores relacionadoscon el uso de mamografía en 1994 y en 2000 en las mujeresespañolas de 40-70 años, y en aquéllas con al menos una mamografíaen los dos años previos.Método: Comparación de los resultados de dos encuestas realizadasen 1994 y en 2000 en sendas muestras de mujeres representativasde las mujeres españolas de 40-70 años (3.218 en 1994 y 2.409en 2000). Se analizaron variables sociodemográficas, socio-sanitariasy de actitudes e información de la mujer.Resultados: De 1994 a 2000 se encuentran diferencias estadísticamentesignificativas en las actitudes, destacando la intención dehacerse una mamografía en el futuro (96% en 2000 vs 79% en 1994)(p<0,0001). El porcentaje de realización de la prueba en el grupo de51-65 años es de 59% en 2000 vs 50% en 1994.Conclusiones: El perfil de las mujeres españolas ha cambiado de1994 a 2000, aunque las mujeres que se habían realizado una mamografíapresentan características sociodemográficas y socio-sanitariassimilares. No obstante, en el año 2000 la mamografía se realiza enmayor medida en el grupo de 51-65 años de edad y las mujeres muestranactitudes más positivas ante la mamografía

Background: The screening mammography is the most highlyeffective procedure for early breast cancer detection. This study isaimed at ascertaining the differences in the factors related to Spanishwomen 40-70 years of age having had mammograms in 1994and 2000 and among those having had at least one mammogramwithin the two years prior.Method: Comparison of the results of two surveys conducted in1994 and 2000, each on samples of women representative of Spanishwomen 40-70 years of age (3,218 in 1994 and 2,409 in 2000). Ananalysis was made of sociodemographic, sociosanitary and thewomen's attitude and awareness-related variables.Results: Statistically significant differences were found between1994 and 2000, the intention of having a mammogram in the future(96% in 2000 vs. 79% in 1994) (p<0.0001). A total of 59% of the 51-65 age group had a mammogram in 2000, as compared to the 50%who had one in 1994.Conclusions: The profile of Spanish women has undergone achange from 1994 to 2000, although those women who had had amammogram were of similar sociodemographic and sociosanitarycharacteristics. However, the screening is being done to a greaterextent on the age 51-65 age group in 2000, and the women are showingmore positive attitudes toward having a mammogram

[Differences in the factors related to the use of mammograms among Spanish women in 1994 and 2000]. / Diferencias en los factores relacionados con el uso de la mamografía en las mujeres españolas en los años 1994 y 2000.

BACKGROUND: The screening mammography is the most highly effective procedure for early breast cancer detection. This study is aimed at ascertaining the differences in the factors related to Spanish women 40-70 years of age having had mammograms in 1994 and 2000 and among those having had at least one mammogram within the two years prior. METHOD: Comparison of the results of two surveys conducted in 1994 and 2000, each on samples of women representative of Spanish women 40-70 years of age (3,218 in 1994 and 2,409 in 2000). An analysis was made of sociodemographic, sociosanitary and the women's attitude and awareness-related variables. RESULTS: Statistically significant differences were found between 1994 and 2000, the intention of having a mammogram in the future (96% in 2000 vs. 79% in 1994) (p<0.0001). A total of 59% of the 51-65 age group had a mammogram in 2000, as compared to the 50% who had one in 1994. CONCLUSIONS: The profile of Spanish women has undergone a change from 1994 to 2000, although those women who had had a mammogram were of similar sociodemographic and sociosanitary characteristics. However, the screening is being done to a greater extent on the age 51-65 age group in 2000, and the women are showing more positive attitudes toward having a mammogram.