1Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
2Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; and.
J Neurosurg Spine. 2024 Sep 6;41(6):746-756. doi: 10.3171/2024.5.SPINE24207. Print 2024 Dec 1.
Robot guidance (RG) and computer-assisted navigation (CAN) have been increasingly utilized for posterior cervical screw placement in cervical spine surgery, and cervical screw malposition may contribute to catastrophic complications. However, the superiority of the navigation using RG or CAN compared with conventional freehand (FH) techniques remains controversial, and no meta-analysis comparing the two methods in cervical spine surgery has been performed.
The PubMed, Embase, Web of Science, Cochrane, China National Knowledge Infrastructure, and Wanfang databases were searched for eligible literature. Studies reporting the primary outcomes of the accuracy of cervical screw placement using RG or CAN compared with FH techniques were included. Bias was evaluated using the Cochrane risk of bias criteria and the Newcastle-Ottawa Scale. The outcomes were evaluated in terms of odds ratio or standardized mean difference and corresponding 95% confidence interval.
One randomized controlled trial and 18 comparative cohort studies published between 2012 and 2023 consisting of 946 patients and 4163 cervical screws were included in this meta-analysis. The RG and CAN techniques were associated with a substantially higher rate of optimal and clinically acceptable cervical screw accuracy than FH techniques. Furthermore, compared with the FH group, the navigation group showed fewer postoperative adverse events, less blood loss, shorter hospital lengths of stay, and lower postoperative Neck Disability Index scores. However, the navigation and FH groups had equivalent intraoperative times and postoperative visual analog scale and Japanese Orthopaedic Association scores at the final follow-up.
Both RG and CAN are superior to FH techniques in terms of the accuracy of cervical screw placement. Navigation techniques, including RG and CAN methods, are accurate, safe, and feasible in cervical spine surgery.
机器人引导（RG）和计算机辅助导航（CAN）已越来越多地用于颈椎手术中的后路颈椎螺钉放置，颈椎螺钉位置不当可能导致灾难性并发症。然而，与传统徒手（FH）技术相比，导航使用 RG 或 CAN 的优势仍存在争议，并且尚未进行比较这两种方法在颈椎手术中的荟萃分析。
检索 PubMed、Embase、Web of Science、Cochrane、中国国家知识基础设施和万方数据库中符合条件的文献。纳入报告使用 RG 或 CAN 与 FH 技术比较颈椎螺钉放置准确性的主要结果的研究。使用 Cochrane 偏倚风险标准和 Newcastle-Ottawa 量表评估偏倚。使用比值比或标准化均数差及其相应的 95%置信区间评估结果。
这项荟萃分析纳入了一项随机对照试验和 18 项比较队列研究，发表时间为 2012 年至 2023 年，共包括 946 名患者和 4163 枚颈椎螺钉。与 FH 技术相比，RG 和 CAN 技术与更高的最佳和临床可接受的颈椎螺钉准确性率相关。此外，与 FH 组相比，导航组术后不良事件更少，出血量更少，住院时间更短，术后颈部残疾指数评分更低。然而，导航组和 FH 组在最终随访时的术中时间、术后视觉模拟量表和日本矫形协会评分相当。
在颈椎螺钉放置的准确性方面，RG 和 CAN 均优于 FH 技术。导航技术，包括 RG 和 CAN 方法，在颈椎手术中是准确、安全且可行的。
