scholarly journals 727 Robotic Assisted Versus Fluoroscopic Guided Approach in Pedicle Screw Insertion: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T K Tan ◽  
J Y Tan ◽  
K T Ng ◽  
S Ahuja
Keyword(s):  
Pedicle Screw ◽  
Facet Joint ◽  
Meta Analysis ◽  
Robotic Group ◽  
Robotic Assisted ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Robotic Assisted Surgery ◽  
Surgical Subspecialty ◽  
Significant Difference

Abstract Aim The robotic assisted surgery has become prevalent in most of the surgical subspecialty. The adaption of such technique in spine surgery has resulted in minimising several issues encountered with fluoroscopic guided approach. The aim of this study is to compare the outcomes of robotic assisted approach and fluoroscopic guided approach in pedicle screw insertion. Method PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched from its inception until November 2020. All the studies comparing robotic assisted surgery and fluoroscopic guided approach in pedicle screw insertion were included for quantitative and qualitative analysis. Results Twenty-eight studies enrolling 2105 patients (robotic group: 1027, fluoroscopic: 1078) and total screws of 8668 screws (robotic group: 4217, fluoroscopic group: 4451) were eligible for inclusion, these studies consisted of 19 observational studies, 7 randomised controlled trials (RCTs) and 2 cadaveric study. Robotic assisted approach was associated with significantly higher accuracy (Grade A+B) (OR = 2.34; P < 0.0001) and distance between pedicle and screw (MD: 1.69; P = 0.001), lower incident of facet joint violation (OR = 0.22; P < 0.00001), screw revision (OR = 0.38; P = 0.009), intraoperative blood loss (MD: -116.95; P = 0.0006), shorter pedicle screw placement time (MD: -4.66; P < 0.00001), radiation exposure time (MD:-5.27; P = 0.0001), radiation dose (MD:-22.30; P = 0.0002) and postoperative hospital stay (MD: -0.79; P = 0.02) compared to fluoroscopic guided approach. There was no significant difference in operative time and wound infection. Conclusions In this meta-analysis, robotic assisted approach is more effective in achieving better clinical outcomes compared to fluoroscopic guided technique in pedicle screw insertion. However, future adequately powered RCTs are warranted to generate standardised outcomes.

scholarly journals Does the application of Robotics improve outcomes of pedicle screw insertion in spine surgery compared to conventional fluoroscopy guidance? A protocol for Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Vishal Kumar ◽  
Vishnu Baburaj ◽  
Prasoon Kumar ◽  
Sarvdeep Singh Dhatt
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Meta Analysis ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Fluoroscopy Guidance

AbstractBackgroundPedicle screw insertion is routinely carried out in spine surgery that has traditionally been performed under fluoroscopy guidance. Robotic guidance has recently gained popularity in order to improve the accuracy of screw placement. However, it is unclear whether the use of robotics alters the accuracy of screw placement or clinical outcomes.ObjectivesThis systematic review aims to compare the results of pedicle screws inserted under fluoroscopy guidance, with those inserted under robotic guidance, in terms of both short-term radiographic outcomes, as well as long-term clinical outcomes.MethodsThis systematic review will be conducted according to the PRISMA guidelines. A literature search will be conducted on the electronic databases of PubMed, Embase, Scopus, and Ovid with a pre-determined search strategy. A manual bibliography search of included studies will also be done. Original articles in English that directly compare pedicle screw insertion under robotic guidance to those inserted under fluoroscopy guidance will be included. Data on outcomes will be extracted from included studies and analysis carried out with the help of appropriate software.

Incidence and Risk Factors of Adjacent Cranial Facet Joint Violation Following Pedicle Screw Insertion Using Cortical Bone Trajectory Technique

Spine ◽  
2016 ◽  
Vol 41 (14) ◽  
pp. E851-E856 ◽  
Author(s):  
Keitaro Matsukawa ◽  
Takashi Kato ◽  
Yoshiyuki Yato ◽  
Hiroshi Sasao ◽  
Hideaki Imabayashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cortical Bone ◽  
Pedicle Screw ◽  
Facet Joint ◽  
Cortical Bone Trajectory ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Facet Joint Violation

scholarly journals How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar vertebrae: Analysis base on three-dimensional CT reconstruction of patients in the prone position

2020 ◽  
Author(s):  
Chao Xu ◽  
Qingxian Hou ◽  
Yanchen Chu ◽  
Xiuling Huang ◽  
Wenjiu Yang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Prone Position ◽  
Vertebral Body ◽  
Supine Position ◽  
Three Dimensional ◽  
Vena Cava ◽  
Ct Reconstruction ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Significant Difference

Abstract Background: Through the comparison of three-dimensional CT reconstruction between the supine position and the prone position, the relative position of thoracolumbar great vessels and vertebral body was studied, and the shortest safe distance between them was measured to improve the safety of bicortical pedicle screw insertion and reduce the risk of vascular injury. Methods: Forty adults were selected to participate the research. Three-dimensional reconstruction of thoracolumbar (T9-L3) CT was performed in the prone position and the supine position. The relative distance between the Aorta/Inferior Vena Cava (IVC) and vertebral body was obtained as AVD/VVD respectively. The relative angle of the Aorta/ IVC and the vertebral body was calculated as ∠AOY/∠VOY. Self-controlled experiments were carried out in the prone and the supine positions, and the data obtained were analyzed using SPSS 22.0 statistical software. Results: The AVD of the prone position and the supine position was the shortest at T12 (3.18 ±0.68mm), but the difference was not statistically significant. The aorta of the T9-L3 segment was shifted from the anterolateral to the anteromedial. The ∠AOY of the other groups differed significantly between the prone and supine positions in all vertebrae except L1 (P < 0.05), and the aorta in the prone position was more anteromedial than that of supine position. With regard to VVD/∠VOY, there was no significant difference between the prone and supine positions (P≥0.05), and the minimum VVD of L3 segment is greater than 5.4mm. The IVC has no obvious mobility and is fixed in the range of 20 °~ 30 ° near the midline. Conclusion: When using bicortical anchoring of pedicle screws, it is safe to ensure that the protruding tips of the screw is less than 3mm. Due to the mobility of the aorta in different postures and individual differences in anatomy, the prone position CT can help doctors to make better preoperative plans and decisions.

scholarly journals Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

2010 ◽  
Vol 20 (6) ◽  
pp. 846-859 ◽  
Author(s):  
Nai-Feng Tian ◽  
Qi-Shan Huang ◽  
Ping Zhou ◽  
Yang Zhou ◽  
Rui-Kai Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Comparative Studies ◽  
Meta Analysis ◽  
Screw Insertion ◽  
Pedicle Screw Insertion

Comparison of the Accuracy of C1 Pedicle Screw Fixation Using Fluoroscopy and Free-Hand Techniques in Patients With Posterior Arch Thickness of Less Than 4 mm

2020 ◽  
Vol 19 (4) ◽  
pp. 429-435
Author(s):  
Byung-Jou Lee ◽  
Myeongjong Kim ◽  
Seong Kyun Jeong ◽  
Subum Lee ◽  
Sang-Ryong Jeon ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screw Fixation ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Insertion Method ◽  
Significant Difference ◽  
Free Hand Technique ◽  
Patient Radiation Exposure

Abstract BACKGROUND C1 pedicle screw insertion is not easy, and more fluoroscopy can be required for safe insertion. Fluoroscopy is time consuming and increases patient radiation exposure. There have been no studies comparing the accuracy of C1 pedicle screw insertion using the fluoroscopy and free-hand techniques. OBJECTIVE To describe a free-hand C1 pedicle screw insertion method in patients with the posterior arch thickness of less than 4 mm in the thinnest part of the groove, and to compare the clinical and radiological outcomes of C1 pedicle screw insertion using fluoroscopy vs using the free-hand technique. METHODS A total of 25 patients who had atlantoaxial instability with a C1 posterior arch &lt;4 mm and were treated with C1 pedicle screw insertion were included. In 10 patients, fluoroscopy was used for C1 pedicle screw insertion, and 15 patients underwent the free-hand technique. We compared the radiologic and clinical outcomes between the 2 groups. RESULTS In patients who underwent the free-hand technique, 96.5% of screws were rated as safe (grade A or B), and 80.0% of screws in the fluoroscopy group were rated as safe. Postoperative occipital neuralgia occurred in one patient in the fluoroscopy group and did not occur in the free-hand technique group. There was no significant difference in the improvement of Nurick grade between the 2 groups. CONCLUSION C1 pedicle screw insertion using the free-hand technique is feasible and safe in patients with a C1 posterior arch &lt;4 mm.

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