Robot-assisted pedicle screw insertion versus navigation-based and freehand techniques for posterior spinal fusion in scoliosis: a systematic review and meta-analysis.

PURPOSE: The role of robotics in spine surgery remains controversial, especially for scoliosis correction surgery. This study aims to assess the safety and efficacy of robotic-assisted (RA) surgery specifically for scoliosis surgery by comparing RA to both navigation systems (NS) and conventional freehand techniques (CF). METHODS: As per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a systematic review and meta-analysis were conducted via an electronic search of the following databases: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). All papers comparing RA to either NS or CF for posterior spinal fusion in scoliosis were included. Fixed and random effects models of analysis were utilised based on analysis heterogeneity. RESULTS: 10 observational studies were included in total. RA had significantly greater odds of accurate pedicle screw placement relative to both NS (OR = 2.02, CI = 1.52-2.67, p < 0.00001) and CF (OR = 3.06, CI = 1.79-5.23, p < 0.00001). The downside of RA was the significantly greater operation duration relative to NS (MD = 10.74, CI = 3.52-17.97, p = 0.004) and CF (MD = 40.27, CI = 20.90, p < 0.0001). Perioperative outcomes including estimated blood loss, radiation exposure, length of hospital stay, cobb angle correction rate, postoperative SRS score, VAS pain score, JOA score, as well as rates of neurological injury and revision surgery, were comparable between the groups (p > 0.05). CONCLUSION: RA offers significantly greater pedicle screw placement accuracy relative to NS and CF, however, surgery can take longer. In terms of perioperative outcomes, all three techniques are comparable.

Children's Mental Health in the Time of COVID-19: How Things Stand and the Aftermath.

Currently, the world is facing immediate and unexpected changes every day due to the coronavirus disease 2019 (COVID-19) pandemic. These environmental stimulations have an impact on mental health, particularly in the case of children. Worldwide measures such as quarantine, social and physical distancing, and school closure can potentially take a toll on children's mental health, in both the short and long terms. Grief, adjustment disorder and acute stress disorder (ASD) are some of the mental health issues that children are prone to suffer during a pandemic, leading to mood disorder, psychosis and even suicidal tendency, if not addressed and treated timely. As the pandemic continues, it is crucial to monitor children's mental health status. Parents/caregivers must receive continuous guidance on handling the situation appropriately. Both professionals and families/caregivers must tend to children's mental health needs to safeguard their overall well-being.