Efficacy of robot-assisted pedicle screw placement: an overview of systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

SUN Wenxi ¹ , GAO Zehui ¹ , QIU Mingwang ¹ , LIN Rui ² , WANG Hongshen ² ,  CHEN Bolai ³ ,  LIN Yongpeng ³

1. Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China;
2. Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, P. R. China;
3. State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510120, P. R. China;

Corresponding author：

CHEN Bolai, Email: chenbolai@gzucm.edu.cn; LIN Yongpeng, Email: drlinyp@gzucm.edu.cn

Keywords：

Orthopedic surgical robot; Pedicle screws; Overview of systematic review

DOI：

10.7507/1672-2531.202308176

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To re-evaluate the systematic review and meta-analysis (SR/MAs) of the efficacy of robot-assisted pedicle screw placement. Methods The CNKI, VIP, WanFang Data, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases were electronically searched to collect SR/MAs of robot-assisted pedicle screw placement from inception to April 28, 2023. Two reviewers independently screened literature, extracted data and then assessed the quality of reports, methodological quality, risk of bias, and the strength of evidence quality by using PRISMA, AMSTAR-Ⅱ, ROBIS, and GRADE tool. Results A total of 20 SR/MAs were included. The results of the included studies showed that robot-assisted pedicle screw placement was more accurate and had a lower number of complications compared with freehand pedicle screw placement. The quality of reports, methodology, and evidence for pedicle screw placement efficiency in all SR/MAs were low or extremely low, with a high risk of bias. The main reasons included high heterogeneity of included studies, unclear research methods and selection criteria, and missing key reporting processes. Conclusion Robot-assisted pedicle screw placement may have better clinical efficiency than traditional freehand pedicle screw placement. But the quality of relational SR/MAs is low.

Citation： SUN Wenxi, GAO Zehui, QIU Mingwang, LIN Rui, WANG Hongshen, CHEN Bolai, LIN Yongpeng. Efficacy of robot-assisted pedicle screw placement: an overview of systematic review. Chinese Journal of Evidence-Based Medicine, 2024, 24(5): 584-590. doi: 10.7507/1672-2531.202308176 Copy

1.	GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
2.	Ross PD, Davis JW, Epstein RS, et al. Pain and disability associated with new vertebral fractures and other spinal conditions. J Clin Epidemiol, 1994, 47(3): 231-239.
3.	Gaines RW. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am, 2000, 82(10): 1458-1476.
4.	Gao S, Wei J, Li W, et al. Accuracy of robot-assisted percutaneous pedicle screw placement under regional anesthesia: a retrospective cohort study. Pain Res Manag, 2021, 2021: 6894001.
5.	Wei FL, Gao QY, Heng W, et al. Association of robot-assisted techniques with the accuracy rates of pedicle screw placement: a network pooling analysis. EClinicalMedicine, 2022, 48: 101421.
6.	Lieber AM, Kirchner GJ, Kerbel YE, et al. Robotic-assisted pedicle screw placement fails to reduce overall postoperative complications in fusion surgery. Spine J, 2019, 19(2): 212-217.
7.	Kirchner GJ, Kim AH, Kwart AH, et al. Reported events associated with spine robots: an analysis of the food and drug administration's manufacturer and user facility device experience database. Global Spine J, 2023, 13(3): 855-860.
8.	Tarawneh AM, Salem KM. A systematic review and meta-analysis of randomized controlled trials comparing the accuracy and clinical outcome of pedicle screw placement using robot-assisted technology and conventional freehand technique. Global Spine J, 2021, 11(4): 575-586.
9.	Li HM, Zhang RJ, Shen CL. Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials: a meta-analysis. Spine (Phila Pa 1976), 2020, 45(2): E111-E119.
10.	Peng YN, Tsai LC, Hsu HC, et al. Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials. Ann Transl Med, 2020, 8(13): 824.
11.	Li C, Li W, Gao S, et al. Comparison of accuracy and safety between robot-assisted and conventional fluoroscope assisted placement of pedicle screws in thoracolumbar spine: a meta-analysis. Medicine (Baltimore), 2021, 100(38): e27282.
12.	Zhou LP, Zhang RJ, Li HM, et al. Comparison of cranial facet joint violation rate and four other clinical indexes between robot-assisted and freehand pedicle screw placement in spine surgery: a meta-analysis. Spine (Phila Pa 1976), 2020, 45(22): E1532-E1540.
13.	Liu H, Chen W, Wang Z, et al. Comparison of the accuracy between robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis. Int J Comput Assist Radiol Surg, 2016, 11(12): 2273-2281.
14.	Luengo-Matos S, Sánchez-Gómez LM, Hijas-Gómez AI, et al. Efficacy and safety of robotic spine surgery: systematic review and meta-analysis. J Orthop Traumatol, 2022, 23(1): 49.
15.	Gao S, Lv Z, Fang H. Robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis of randomized controlled trials. Eur Spine J, 2018, 27(4): 921-930.
16.	Fu W, Tong J, Liu G, et al. Robot-assisted technique vs conventional freehand technique in spine surgery: a meta-analysis. Int J Clin Pract, 2021, 75(5): e13964.
17.	Yu L, Chen X, Margalit A, et al. Robot-assisted vs freehand pedicle screw fixation in spine surgery - a systematic review and a meta-analysis of comparative studies. Int J Med Robot, 2018, 14(3): e1892.
18.	Lopez IB, Benzakour A, Mavrogenis A, et al. Robotics in spine surgery: systematic review of literature. Int Orthop, 2023, 47(2): 447-456.
19.	Zhou LP, Zhang ZG, Li D, et al. Robotics in cervical spine surgery: feasibility and safety of posterior screw placement. Neurospine, 2023, 20(1): 329-339.
20.	Fatima N, Massaad E, Hadzipasic M, et al. Safety and accuracy of robot-assisted placement of pedicle screws compared to conventional free-hand technique: a systematic review and meta-analysis. Spine J, 2021, 21(2): 181-192.
21.	Ghasem A, Sharma A, Greif DN, et al. The arrival of robotics in spine surgery: a review of the literature. Spine (Phila Pa 1976), 2018, 43(23): 1670-1677.
22.	Li J, Fang Y, Jin Z, et al. The impact of robot-assisted spine surgeries on clinical outcomes: a systemic review and meta-analysis. Int J Med Robot, 2020, 16(6): 1-14.
23.	杨硕, 刘爱峰, 王秋凤, 等. 机器人辅助与常规徒手开放椎弓根螺钉内固定的精确性与安全性的Meta分析. 国际生物医学工程杂志, 2017, 40(4): 244-251, 后插8.
24.	高松森, 周鲁平, 曹云, 等. 机器人辅助与徒手置入椎弓根螺钉准确性和安全的Meta分析. 颈腰痛杂志, 2022, 43(1): 1-9.
25.	高阳阳, 车先达, 韩鹏飞, 等. 透视引导与机器人辅助椎弓根置钉效果的荟萃分析. 中国组织工程研究, 2020, 24(3): 446-452.
26.	徐朝健, 韩鹏飞, 武壮壮, 等. 导航机器人与透视引导椎弓根置钉的Meta分析. 中国组织工程研究, 2020, 24(18): 2932-2938.
27.	韩鹏飞, 张芝良, 陈成龙, 等. 机器人辅助椎弓根置钉治疗老年脊柱退行性疾病的Meta分析. 中华老年骨科与康复电子杂志, 2019, 5(1): 39-47.
28.	Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021, 372: n71.
29.	Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
30.	Whiting P, Savović J, Higgins JP, et al. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol, 2016, 69: 225-234.
31.	Cui GY, Han XG, Wei Y, et al. Robot-assisted minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar spondylolisthesis. Orthop Surg, 2021, 13(7): 1960-1968.
32.	Fan M, Liu Y, He D, et al. Improved accuracy of cervical spinal surgery with robot-assisted screw insertion: a prospective, randomized, controlled study. Spine (Phila Pa 1976), 2020, 45(5): 285-291.
33.	Lee NJ, Leung E, Buchanan IA, et al. A multicenter study of the 5-year trends in robot-assisted spine surgery outcomes and complications. J Spine Surg, 2022, 8(1): 9-20.
34.	Ringel F, Stüer C, Reinke A, et al. Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: a prospective randomized comparison to conventional freehand screw implantation. Spine (Phila Pa 1976), 2012, 37(8): E496-E501.
35.	Naik A, Smith AD, Shaffer A, et al. Evaluating robotic pedicle screw placement against conventional modalities: a systematic review and network meta-analysis. Neurosurg Focus, 2022, 52(1): E10.
36.	赵树雄, 王增平, 邹月超, 等. 机器人辅助与传统透视下椎弓根螺钉内固定术治疗胸腰椎骨折的荟萃分析. 脊柱外科杂志, 2023, 21(4): 263-274.

1. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
2. Ross PD, Davis JW, Epstein RS, et al. Pain and disability associated with new vertebral fractures and other spinal conditions. J Clin Epidemiol, 1994, 47(3): 231-239.
3. Gaines RW. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am, 2000, 82(10): 1458-1476.
4. Gao S, Wei J, Li W, et al. Accuracy of robot-assisted percutaneous pedicle screw placement under regional anesthesia: a retrospective cohort study. Pain Res Manag, 2021, 2021: 6894001.
5. Wei FL, Gao QY, Heng W, et al. Association of robot-assisted techniques with the accuracy rates of pedicle screw placement: a network pooling analysis. EClinicalMedicine, 2022, 48: 101421.
6. Lieber AM, Kirchner GJ, Kerbel YE, et al. Robotic-assisted pedicle screw placement fails to reduce overall postoperative complications in fusion surgery. Spine J, 2019, 19(2): 212-217.
7. Kirchner GJ, Kim AH, Kwart AH, et al. Reported events associated with spine robots: an analysis of the food and drug administration's manufacturer and user facility device experience database. Global Spine J, 2023, 13(3): 855-860.
8. Tarawneh AM, Salem KM. A systematic review and meta-analysis of randomized controlled trials comparing the accuracy and clinical outcome of pedicle screw placement using robot-assisted technology and conventional freehand technique. Global Spine J, 2021, 11(4): 575-586.
9. Li HM, Zhang RJ, Shen CL. Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials: a meta-analysis. Spine (Phila Pa 1976), 2020, 45(2): E111-E119.
10. Peng YN, Tsai LC, Hsu HC, et al. Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials. Ann Transl Med, 2020, 8(13): 824.
11. Li C, Li W, Gao S, et al. Comparison of accuracy and safety between robot-assisted and conventional fluoroscope assisted placement of pedicle screws in thoracolumbar spine: a meta-analysis. Medicine (Baltimore), 2021, 100(38): e27282.
12. Zhou LP, Zhang RJ, Li HM, et al. Comparison of cranial facet joint violation rate and four other clinical indexes between robot-assisted and freehand pedicle screw placement in spine surgery: a meta-analysis. Spine (Phila Pa 1976), 2020, 45(22): E1532-E1540.
13. Liu H, Chen W, Wang Z, et al. Comparison of the accuracy between robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis. Int J Comput Assist Radiol Surg, 2016, 11(12): 2273-2281.
14. Luengo-Matos S, Sánchez-Gómez LM, Hijas-Gómez AI, et al. Efficacy and safety of robotic spine surgery: systematic review and meta-analysis. J Orthop Traumatol, 2022, 23(1): 49.
15. Gao S, Lv Z, Fang H. Robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis of randomized controlled trials. Eur Spine J, 2018, 27(4): 921-930.
16. Fu W, Tong J, Liu G, et al. Robot-assisted technique vs conventional freehand technique in spine surgery: a meta-analysis. Int J Clin Pract, 2021, 75(5): e13964.
17. Yu L, Chen X, Margalit A, et al. Robot-assisted vs freehand pedicle screw fixation in spine surgery - a systematic review and a meta-analysis of comparative studies. Int J Med Robot, 2018, 14(3): e1892.
18. Lopez IB, Benzakour A, Mavrogenis A, et al. Robotics in spine surgery: systematic review of literature. Int Orthop, 2023, 47(2): 447-456.
19. Zhou LP, Zhang ZG, Li D, et al. Robotics in cervical spine surgery: feasibility and safety of posterior screw placement. Neurospine, 2023, 20(1): 329-339.
20. Fatima N, Massaad E, Hadzipasic M, et al. Safety and accuracy of robot-assisted placement of pedicle screws compared to conventional free-hand technique: a systematic review and meta-analysis. Spine J, 2021, 21(2): 181-192.
21. Ghasem A, Sharma A, Greif DN, et al. The arrival of robotics in spine surgery: a review of the literature. Spine (Phila Pa 1976), 2018, 43(23): 1670-1677.
22. Li J, Fang Y, Jin Z, et al. The impact of robot-assisted spine surgeries on clinical outcomes: a systemic review and meta-analysis. Int J Med Robot, 2020, 16(6): 1-14.
23. 杨硕, 刘爱峰, 王秋凤, 等. 机器人辅助与常规徒手开放椎弓根螺钉内固定的精确性与安全性的Meta分析. 国际生物医学工程杂志, 2017, 40(4): 244-251, 后插8.
24. 高松森, 周鲁平, 曹云, 等. 机器人辅助与徒手置入椎弓根螺钉准确性和安全的Meta分析. 颈腰痛杂志, 2022, 43(1): 1-9.
25. 高阳阳, 车先达, 韩鹏飞, 等. 透视引导与机器人辅助椎弓根置钉效果的荟萃分析. 中国组织工程研究, 2020, 24(3): 446-452.
26. 徐朝健, 韩鹏飞, 武壮壮, 等. 导航机器人与透视引导椎弓根置钉的Meta分析. 中国组织工程研究, 2020, 24(18): 2932-2938.
27. 韩鹏飞, 张芝良, 陈成龙, 等. 机器人辅助椎弓根置钉治疗老年脊柱退行性疾病的Meta分析. 中华老年骨科与康复电子杂志, 2019, 5(1): 39-47.
28. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021, 372: n71.
29. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
30. Whiting P, Savović J, Higgins JP, et al. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol, 2016, 69: 225-234.
31. Cui GY, Han XG, Wei Y, et al. Robot-assisted minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar spondylolisthesis. Orthop Surg, 2021, 13(7): 1960-1968.
32. Fan M, Liu Y, He D, et al. Improved accuracy of cervical spinal surgery with robot-assisted screw insertion: a prospective, randomized, controlled study. Spine (Phila Pa 1976), 2020, 45(5): 285-291.
33. Lee NJ, Leung E, Buchanan IA, et al. A multicenter study of the 5-year trends in robot-assisted spine surgery outcomes and complications. J Spine Surg, 2022, 8(1): 9-20.
34. Ringel F, Stüer C, Reinke A, et al. Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: a prospective randomized comparison to conventional freehand screw implantation. Spine (Phila Pa 1976), 2012, 37(8): E496-E501.
35. Naik A, Smith AD, Shaffer A, et al. Evaluating robotic pedicle screw placement against conventional modalities: a systematic review and network meta-analysis. Neurosurg Focus, 2022, 52(1): E10.
36. 赵树雄, 王增平, 邹月超, 等. 机器人辅助与传统透视下椎弓根螺钉内固定术治疗胸腰椎骨折的荟萃分析. 脊柱外科杂志, 2023, 21(4): 263-274.

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