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

ABSTRACT

BACKGROUND: Traditional fluoroscopy-guided pedicle screw fixation is not highly accurate and can lead to serious surgical complications. To reduce surgical complications and improve the success rate of surgery, robotic assistive technology emerges as the times require. OBJECTIVE: To compare the difference of robot-assisted and fluoroscopy-guided pedicle screw placement using meta-analysis. METHODS: The study included clinical controlled trials on robot-assisted and fluoroscopy-guided pedicle screw placement published in and outside China from December 2008 to December 2018. The retrieval was performed in the online databases include Embase, PubMed, Central, CNKI, CQVIP, Wanfang, and CBM. Keywords used for search were robot assisted, fluoroscopy guided, conventional, freehand, pedicle screw in English and Chinese. After the data were extracted, statistical software Review Manager 5.3 was used for data-analysis. RESULTS AND CONCLUSION: (1) Based on the above search strategy, 1 615 studies were retrieved, and 13 were included. (2) Statistical analysis found that placement accuracy in the robot-assisted group was better than that of the fluoroscopy group [95%CI(1.55, 4.06), P=0.000 2]. Radiation intensity in the fluoroscopy group was lower than that in the robot-assisted group [95%CI(0.42, 0.82), P < 0.001], and the difference was statistically significant. (3) However, the incidence of complications [95%CI(0.23, 4.65), P=0.96] and revised surgery [95%CI(0.03, 3.17), P=0.33] were not statistically significant between the robot-assisted group and the fluoroscopy group. Intraoperative fluoroscopy time was similar between the two groups [95%CI(-38.55, 78.26), P=0.51]. Postoperative back pain [95%CI(-0.58, 0.38), P=0.68], leg pain score [95%CI(-0.20, 0.19), P=0.94] and operation time [95%CI(-6.33, 53.02), P=0.12] were also similar between the two groups, and the differences were not statistically significant. (4) Compared with fluoroscopy, robot-assisted technique has higher pedicle screw placement accuracy, especially under percutaneous conditions. Inevitably, the intraoperative radiation intensity is also more than conventional fluoroscopy.