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Effectiveness and safety of robot-assisted versus fluoroscopy-assisted cortical bone trajectory screw instrumentation in spinal surgery: a systematic review and meta-analysis

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Abstract

Robot-assisted (RA) technology has been shown to be a safe aid in spine surgery, this meta-analysis aims to compare surgical parameters and clinical indexes between robot-assisted cortical bone trajectory (CBT) and fluoroscopy-assisted (FA) cortical bone trajectory in spinal surgery. We searched databases such as PubMed, Web of Science, the Cochrane Library, and the China National Knowledge Infrastructure. The study selection process was guided by the PICOS (Patient/Problem, Intervention, Comparison, Outcome, Study Design) strategy. The risk of bias in non-randomized comparative studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. We performed this meta-analysis using RevMan 5.3 software (Cochrane Collaboration, Copenhagen, Denmark), and the level of statistical significance was set at P < 0.05. Six articles involving 371 patients and 1535 screws were included in this meta-analysis. RA-CBT outperformed FA-CBT in terms of various parameters, such as accuracy of pedicle screw position (both Gertzbein-Robbins scale and Ding scale), avoidance of superior facet joint violation (FJV), and reduction of neurological injury. Our meta-analysis offered a thorough evaluation of the efficacy and safety of RA-CBT in spinal surgery. The findings revealed that RA-CBT produced statistically significant results in terms of pedicle screw position accuracy and superior facet joint violation prevention. In terms of surgical parameters and clinical indexes, future research and clinical practice should investigate the efficacy of RA-CBT further. The study was registered in the PROSPERO (CRD42023466280).

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Data availability

The data sets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

RA:

Robot-assisted

FA:

Fluoroscopy-assisted

CBT:

Cortical bone trajectory

BMI:

Body mass index

BMD:

Bone mineral density

ASD:

Adjacent segmental degeneration

QCT:

Quantitative computed tomography

RCT:

Randomized controlled trial

WMD:

Weighted mean difference

SMD:

Standardized mean difference

CI:

Confidence interval

OR:

Odds ratio

M-H:

Mantel–Haenszel

IV:

Inverse variance

Df:

Degrees of freedom

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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.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  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

Q-SZ and Y-HZ designed the study protocol. XW and H-XL managed the literature search and data acquisition. XW and Y-HZ performed the statistical analysis and drafted the manuscript. Q-SZ provided critical revisions to the manuscript. Q-SZ resolved ambiguities during the study and gave final approval of the manuscript.

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Correspondence to Qing-san Zhu or Yu-hang Zhu.

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Wang, X., Li, Hx., Zhu, Qs. et al. Effectiveness and safety of robot-assisted versus fluoroscopy-assisted cortical bone trajectory screw instrumentation in spinal surgery: a systematic review and meta-analysis. J Robotic Surg 18, 78 (2024). https://doi.org/10.1007/s11701-024-01866-1

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