Tovar Matthew A, Dowlati Ehsan, Zhao David Y, Khan Ziam, Pasko Kory B D, Sandhu Faheem A, Voyadzis Jean-Marc
1School of Medicine and Health Sciences, George Washington University, Washington, DC.
2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC.
J Neurosurg Spine. 2022 Feb 25;37(2):299-314. doi: 10.3171/2022.1.SPINE211345. Print 2022 Aug 1.
The use of technology-enhanced methods in spine surgery has increased immensely over the past decade. Here, the authors present the largest systematic review and meta-analysis to date that specifically addresses patient-centered outcomes, including the risk of inaccurate screw placement and perioperative outcomes in spinal surgeries using robotic instrumentation and/or augmented reality surgical navigation (ARSN).
A systematic review of the literature in the PubMed, EMBASE, Web of Science, and Cochrane Library databases spanning the last decade (January 2011-November 2021) was performed to present all clinical studies comparing robot-assisted instrumentation and ARSN with conventional instrumentation techniques in lumbar spine surgery. The authors compared these two technologies as they relate to screw accuracy, estimated blood loss (EBL), intraoperative time, length of stay (LOS), perioperative complications, radiation dose and time, and the rate of reoperation.
A total of 64 studies were analyzed that included 11,113 patients receiving 20,547 screws. Robot-assisted instrumentation was associated with less risk of inaccurate screw placement (p < 0.0001) regardless of control arm approach (freehand, fluoroscopy guided, or navigation guided), fewer reoperations (p < 0.0001), fewer perioperative complications (p < 0.0001), lower EBL (p = 0.0005), decreased LOS (p < 0.0001), and increased intraoperative time (p = 0.0003). ARSN was associated with decreased radiation exposure compared with robotic instrumentation (p = 0.0091) and fluoroscopy-guided (p < 0.0001) techniques.
Altogether, the pooled data suggest that technology-enhanced thoracolumbar instrumentation is advantageous for both patients and surgeons. As the technology progresses and indications expand, it remains essential to continue investigations of both robotic instrumentation and ARSN to validate meaningful benefit over conventional instrumentation techniques in spine surgery.
在过去十年中，脊柱手术中技术增强方法的使用大幅增加。在此，作者呈现了迄今为止规模最大的系统评价和荟萃分析，专门探讨以患者为中心的结局，包括使用机器人器械和/或增强现实手术导航（ARSN）的脊柱手术中螺钉置入不准确的风险及围手术期结局。
对过去十年（2011年1月至2021年11月）PubMed、EMBASE、科学网和考克兰图书馆数据库中的文献进行系统评价，以呈现所有比较机器人辅助器械和ARSN与腰椎手术中传统器械技术的临床研究。作者比较了这两种技术在螺钉准确性、估计失血量（EBL）、手术时间、住院时间（LOS）、围手术期并发症、辐射剂量和时间以及再次手术率方面的差异。
共分析了64项研究，包括11,113例接受20,547枚螺钉置入的患者。无论对照臂方法（徒手、透视引导或导航引导）如何，机器人辅助器械与螺钉置入不准确的风险较低相关（p < 0.0001），再次手术较少（p < 0.0001），围手术期并发症较少（p < 0.0001），EBL较低（p = 0.0005），LOS缩短（p < 0.0001），手术时间增加（p = 0.0003）。与机器人器械（p = 0.0091）和透视引导（p < 0.0001）技术相比，ARSN与辐射暴露减少相关。
总体而言，汇总数据表明技术增强的胸腰椎器械对患者和外科医生均有利。随着技术的进步和适应证的扩大，继续研究机器人器械和ARSN以验证其在脊柱手术中相对于传统器械技术的显著益处仍然至关重要。
