Open AccessRobot‐assisted technique vs conventional freehand technique in spine surgery: A meta‐analysis
Author(s) -
Fu Weiguang,
Tong Jie,
Liu Gang,
Zheng Yuxin,
Wang Shaolei,
Abdelrahim Mohamed E. A.,
Gong Shaohua
Publication year - 2021
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.13964
Subject(s) - medicine , confidence interval , odds ratio , meta analysis , mean difference , surgery , significant difference , facet (psychology) , nuclear medicine , orthodontics , psychology , social psychology , personality , big five personality traits
Background The impact of robot‐assisted techniques versus conventional freehand techniques in terms of the accuracy of pedicle screw placement remains conflicting. This meta‐analysis was performed to evaluate this relationship. Methods A systematic literature search up to July 2020 was performed and 15 studies were detected with 6041 pedicle screw placements with 2748 of them were using robot‐assisted techniques and 3293 were conventional freehand techniques. They reported relationships between robot‐assisted techniques and conventional freehand techniques in pedicle screw placement. Odds ratio (OR) or Mean differences (MD) with 95% confidence intervals (CIs) was calculated comparing the robot‐assisted techniques to conventional freehand techniques in pedicle screw placement risks using the dichotomous and continuous method with a random or fixed‐effect model. Results Robot‐assisted techniques had a significantly higher screw position grade A in Gertzbein‐Robbins classification of the screw placement accuracy (OR, 2.43; 95% CI, 1.66‐3.54, P < .001); shorter postoperative stay (MD, −0.67; 95% CI, −1.16 to −0.19, P < .001); lower intraoperative blood loss (MD, −91.64; 95% CI, −152.44 to −30.83, P = .003); fewer intraoperative radiation dose (MD, −23.52; 95% CI, −40.12 to −6.0.93, P = .005); and low proximal facet violations (MD, 0.08; 95% CI, 0.03‐0.20, P < .001) compared with conventional freehand techniques. However, no significant difference was found between robot‐assisted techniques and conventional freehand techniques in surgical time (OR, 11.71; 95% CI, 03.27‐26.70, P = .13); visual analogue scale scores (MD, −0.15; 95% CI, −0.54 to 0.23, P = .44); and Oswestry disability index scores (MD, 0.21; 95% CI, −5.09‐5.51, P = .94). Conclusions The extent of the improvement with robot‐assisted techniques in screw position grade A in Gertzbein‐Robbins classification of the screw placement accuracy, postoperative stay, intraoperative blood loss, intraoperative radiation dose, and proximal facet violations was significantly better than conventional freehand techniques. This relationship forces us to recommend robot‐assisted techniques for pedicle screw placement to avoid any possible negative postoperative results.