Position and complications of pedicle screw insertion with or without image-navigation techniques in the thoracolumbar spine: a meta-analysis of comparative studies

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.

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In Reply to the Letter to the Editor Regarding “Accuracy of Pedicle Screw Insertion Among 3 Image-Guided Navigation Systems: A Systematic Review and Meta-Analysis”

World Neurosurgery ◽

10.1016/j.wneu.2020.03.196 ◽

2020 ◽

Vol 138 ◽

pp. 598-599

Author(s):

Jinpeng Du ◽

Dageng Huang ◽

Liang Yan ◽

Lequn Shan ◽

Yong Fan ◽

...

Keyword(s):

Systematic Review ◽

Pedicle Screw ◽

Meta Analysis ◽

Navigation Systems ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Image Guided ◽

Letter To The Editor

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

British Journal of Surgery ◽

10.1093/bjs/znab259.787 ◽

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.

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