Revised in-depth meta-analysis on the efficacy of robot-assisted versus traditional free-hand pedicle screw insertion

Abstract

Objective: Robot-assisted pedicle screw insertion has recently emerged as an alternative to the traditional free-hand technique. However, discrepancies in the accuracy of screw placement between the 2 methods have been highlighted by some comparative studies. This meta-analysis was conducted to synthesize evidence comparing these techniques. Methods: Searches were conducted in 5 electronic databases adhering to specific eligibility criteria for randomized and observational studies. The data were analyzed using RevMan software and the results are presented as odds ratios (ORs), mean differences, or standard mean differences (SMDs) with 95% confidence intervals (CIs). Our analysis included 12 studies (7 randomized trials and 5 observational studies, involving 883 patients and 4903 screws). Results: The results demonstrated a higher rate of Grade A Gertzbein and Robbins pedicle placement score (OR: 1.77; 95% CI: 1.10–2.87), a lower rate of revision surgeries (OR: 0.21; 95% CI: 0.09–0.52), and a shorter radiation exposure duration (SMD = −1.38, 95% CI: −2.32 to −0.44) in the robot-assisted group compared with the free-hand group. Nonetheless, the length of hospital stay, volume of intraoperative blood loss, postoperative visual analogue scale scores for back pain, and rate of wound infection were similar between the 2 groups. Significant heterogeneity was observed in some outcomes. Conclusion: Compared with the free-hand method, the robot-assisted technique provides greater accuracy and reduced radiation exposure. The efficacy of the robot-assisted technique is expected to improve further as experience with its use in surgery grows.

Keywords

• Robotic surgery
• Pedicle screw placement
• Free-hand
• Fluoroscopy
• Meta-analysis