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.

Diástasis traumática de pubis en gestante a término / Traumatic diastasis of pubic symphysis in a full-term pregnant

La diástasis traumática de la sínfisis del pubis durante la gestación es una complicación infrecuente aunque potencialmente grave para la madre y el feto que nos obliga a una vigilancia cuidadosa de la estabilidad hemodinámica de ambos y que precisa una actuación conjunta de obstetras y traumatólogos, en ocasiones emergente (AU)

The traumatic diastasis of pubic symphysis during the gestation is a rare although potentially serious complication for the mother and the fetus and that forces us to a careful monitoring of the hemodinámic stability of both and that it needs a joint performance by obstetricians and orthopaedic surgeons sometimes emergent (AU)

Insufficient recovery of neuromuscular activity around the knee after experimental anterior cruciate ligament reconstruction.

BACKGROUND: Operative and nonoperative treatment of anterior cruciate ligament (ACL) injuries is often associated with a lack of proprioception and persistent muscle weakness of unknown origin. METHODS: This long-term study in the cat experimentally compares both neural and muscular activity in the articular nerves of the knee (PAN and MAN), quadriceps and hamstrings, in the chronic unstable knee, and in the reconstructed knee. We also investigated changes in neuromuscular response due to the mechanical competence of the graft, comparing stable and unstable reconstructed knees. RESULTS: We found increased periarticular muscle activity during anterior tibial translation in chronically unstable knees. Both reconstructed and non-reconstructed knees lost fast reactive activity in the articular nerves. When stability was recovered after reconstruction, the knees showed a more adjusted - although incomplete - muscular reaction. INTERPRETATION: ACL-injured knees in the cat, with or without reconstruction, show definite abnormalities in neuromuscular reaction in the long term. Regaining stability with a competent graft in the reconstructed knee is crucial for reduction of this anomalous reaction.