Perna Andrea, Velluto Calogero, Smakaj Amarildo, Tamburrelli Francesco, Borruto Maria Ilaria, Santagada Domenico Alessandro, Gorgoglione Franco Lucio, Liuzza Francesco, Proietti Luca
Department of Geriatrics and Orthopaedics Sciences, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy.
Department of Orthopedics and Trauma Surgery, Fondazione Casa Sollievo Della Sofferenza IRCCS, San Giovanni Rotondo, Italy.
J Neurosci Rural Pract. 2023 Jul-Sep;14(3):406-412. doi: 10.25259/JNRP_147_2023. Epub 2023 Jul 27.
Minimally invasive spine surgery became the gold standard for the treatment of many spinal diseases. Only a few comparative studies were performed regarding the superiority of robotic-assisted (RA) surgery over fluoroscopic guidance (FG) surgery during percutaneous pedicle screws placement. Therefore, the aim of the present study was to conduct a systematic literature review and meta-analysis to evaluate the accuracy and potential advantages of RA compared with FG.
This study is a systematic literature review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The review questions were formulated following the PICO scheme. Measured outcomes were presented using Forest plots. Heterogeneity among the included studies was assessed using the χ test, and the I statistic was utilized to estimate the proportion of total variation among the studies. A value exceeding 50% was considered indicative of substantial heterogeneity.
Seven studies that met inclusion criteria were finally included in this meta-analysis. These seven studies include: 447 patients, 228 patients (931 screws) treated with robotic guide, and 219 patients (767 pedicle screws) using fluoroscopic guide, with a mean age of 55.2. The percentages of clinically acceptable screws were 94.3% in the robot-assisted group and 89% in the fluoroscopic guided group. The percentages of non-acceptable screws were 5.7% in the robot-assisted group and 11% in the fluoroscopic-guided group.
Significant differences were observed between the two groups in terms of radiographic and clinical outcomes, with the robotic-assisted pedicle screw group exhibiting longer operative times. Robot technology serves as a valuable tool for assisting surgeons in challenging scenarios such as anatomical variants or patients with spinal deformities, ensuring accurate screw placement.
The accuracy of pedicle screw placement with robotic technology is higher than with FG. In fact, the robotic approach allows significantly lower complication rates, fewer cases of violation of the proximal articular facet, less intraoperative exposure to radiation, even if it requires longer surgical times than the FG technique.
微创脊柱手术已成为许多脊柱疾病治疗的金标准。在经皮椎弓根螺钉置入过程中，关于机器人辅助（RA）手术相对于透视引导（FG）手术的优越性，仅有少数比较研究。因此，本研究的目的是进行系统的文献综述和荟萃分析，以评估RA与FG相比的准确性和潜在优势。
本研究是一项按照系统评价和荟萃分析的首选报告项目指南进行的系统文献综述。审查问题按照PICO方案制定。使用森林图展示测量结果。使用χ检验评估纳入研究之间的异质性，并使用I统计量估计研究之间总变异的比例。超过50%的值被认为表明存在实质性异质性。
最终，七项符合纳入标准的研究被纳入本荟萃分析。这七项研究包括：447例患者，其中228例患者（931枚螺钉）接受机器人引导治疗，219例患者（767枚椎弓根螺钉）使用透视引导，平均年龄为55.2岁。机器人辅助组临床可接受螺钉的百分比为94.3%，透视引导组为89%。机器人辅助组不可接受螺钉的百分比为5.7%，透视引导组为11%。
两组在影像学和临床结果方面存在显著差异，机器人辅助椎弓根螺钉组的手术时间更长。机器人技术是协助外科医生应对诸如解剖变异或脊柱畸形患者等具有挑战性情况的宝贵工具，可确保螺钉准确置入。
机器人技术置入椎弓根螺钉的准确性高于FG。事实上，机器人手术方法可显著降低并发症发生率，减少近端关节面侵犯病例，减少术中辐射暴露，即使其手术时间比FG技术长。
