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Effectiveness and safety of robot-assisted versus fluoroscopy-assisted pedicle screw implantation in scoliosis surgery: a systematic review and meta-analysis

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Abstract

This study aimed to assess the effectiveness and safety of robot-assisted versus fluoroscopy-assisted pedicle screw implantation in scoliosis surgery. The study was registered in the PROSPERO (CRD42023471837). Two independent researchers searched PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure. The outcomes included operation time, pedicle screw implantation time, blood loss, number of fluoroscopic, accuracy of pedicle screw position, hospital stays, postoperative hospital stays, Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA) score, Scoliosis Research Society-22(SRS-22), cobb angle, cobb angle correction rate, sagittal vertical axis (SVA), and complications. Eight papers involving 473 patients met all the criteria. There was no significant difference between the two groups regarding the reduction in operation time. The effect of reducing the pedicle screw implantation time in the RA group was significant (WMD = -1.28; 95% CI: -1.76 to -0.80; P < 0.00001). The effect of reducing the blood loss in the RA group was significant (WMD=-105.57; 95% CI: -206.84 to -4.31; P = 0.04). The effect of reducing the number of fluoroscopic in the RA group was significant (WMD=-5.93; 95% CI: -8.24 to -3.62; P < ). The pedicle screw position of Grade A was significantly more in the RA group according to both the Gertzbein-Robbins scale and the Rampersaud scale. Compared with the FA group, the difference in the hospital stays in the RA group was not statistically significant, but the effect of reducing the postoperative hospital stays in the RA group was significant (WMD = -2.88; 95% CI: -4.13 to -1.63; P < 0.00001). The difference in the VAS, JOA, SRS-22, Cobb angle and Cobb angle correction rate, SVA, and complications between the two groups was not statistically significant. The robot-assisted technique achieved statistically significant results in terms of pedicle screw placement time, blood loss, number of fluoroscopies, accuracy of pedicle screw position, and postoperative hospital stay.

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Acknowledgements

The authors acknowledged the Department of Statistics, Public Health College of Jilin University for their suggestions concerning the statistical analysis in this manuscript.

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  1. Yu-hang Zhu and Qing-san Zhu contributed equally to this study and should be considered co-corresponding authors.

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  1. Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, Jilin, China

    Xu Wang, Hao-xuan Li, Qing-san Zhu & Yu-hang Zhu

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Contributions

Qing-san Zhu and Yu-hang Zhu designed the study protocol. Xu Wang and Hao-xuan Li managed the literature search and data acquisition. Xu Wang and Yu-hang Zhu performed the statistical analysis and drafted the manuscript. Qing-san Zhu provided critical revisions to the manuscript. Qing-san Zhu resolved ambiguities during the study and gave final approval of the manuscript. Yu-hang Zhu and Qing-san Zhu contributed equally to this study and should be considered co-corresponding authors.

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Wang, X., Li, Hx., Zhu, Qs. et al. Effectiveness and safety of robot-assisted versus fluoroscopy-assisted pedicle screw implantation in scoliosis surgery: a systematic review and meta-analysis. Neurosurg Rev 47, 108 (2024). https://doi.org/10.1007/s10143-024-02340-0

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