Evaluating robotic pedicle screw placement against conventional modalities: a systematic review and network meta-analysis.

Autor:	Naik A; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and., Smith AD; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and., Shaffer A; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and., Krist DT; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and., Moawad CM; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and., MacInnis BR; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and., Teal K; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and.; 2Department of Neurosurgery, Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, Illinois., Hassaneen W; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and.; 2Department of Neurosurgery, Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, Illinois., Arnold PM; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and.; 2Department of Neurosurgery, Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, Illinois.
Jazyk:	angličtina
Zdroj:	Neurosurgical focus [Neurosurg Focus] 2022 Jan; Vol. 52 (1), pp. E10.
DOI:	10.3171/2021.10.FOCUS21509
Abstrakt:	Objective: Several approaches have been studied for internal fixation of the spine using pedicle screws (PSs), including CT navigation, 2D and 3D fluoroscopy, freehand, and robotic assistance. Robot-assisted PS placement has been controversial because training requirements, cost, and previously unclear benefits. This meta-analysis compares screw placement accuracy, operative time, intraoperative blood loss, and overall complications of PS insertion using traditional freehand, navigated, and robot-assisted methods. Methods: A systematic review was performed of peer-reviewed articles indexed in several databases between January 2000 and August 2021 comparing ≥ 2 PS insertion methods with ≥ 10 screws per treatment arm. Data were extracted for patient outcomes, including PS placement, misplacement, and accuracy; operative time, overall complications, intraoperative blood loss, postoperative hospital length of stay, postoperative Oswestry Disability Index (ODI) score, and postoperative visual analog scale (VAS) score for back pain. Risk of bias was assessed using the Newcastle-Ottawa score and Cochrane tool. A network meta-analysis (NMA) was performed to estimate PS placement accuracy as the primary outcome. Results: Overall, 78 studies consisting of 6262 patients and > 31,909 PSs were included. NMA results showed that robot-assisted and 3D-fluoroscopy PS insertion had the greatest accuracy compared with freehand (p < 0.01 and p < 0.001, respectively), CT navigation (p = 0.02 and p = 0.04, respectively), and 2D fluoroscopy (p < 0.01 and p < 0.01, respectively). The surface under the cumulative ranking (SUCRA) curve method further demonstrated that robot-assisted PS insertion accuracy was superior (S = 0.937). Optimal screw placement was greatest in robot-assisted (S = 0.995) placement, and misplacement was greatest with freehand (S = 0.069) approaches. Robot-assisted placement was favorable for minimizing complications (S = 0.876), while freehand placement had greater odds of complication than robot-assisted (OR 2.49, p < 0.01) and CT-navigation (OR 2.15, p = 0.03) placement. Conclusions: The results of this NMA suggest that robot-assisted PS insertion has advantages, including improved accuracy, optimal placement, and minimized surgical complications, compared with other PS insertion methods. Limitations included overgeneralization of categories and time-dependent effects.
Databáze:	MEDLINE
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