An early evaluation of robot-assisted and conventional techniques for posterior approach atlantoaxial displacement instrumentation - a systematic review and meta-analysis.

Atlantoaxial dislocation (AAD) is a serious condition in which the first two cervical vertebrae lose their anatomical position and stability. This may lead to neurological complications, including death. The treatment of AAD remains controversial, and posterior instrumentation with pedicle screw placement is one of the commonly used methods. The goal of this study is to evaluate the effectiveness of robot-assisted (RA) surgery compared to conventional techniques for posterior AAD instrumentation. Following Cochrane and PRISMA guidelines, five major databases were searched from inception to December 2024. Studies evaluating RA surgery compared to freehand (FH) or computer navigation methods were included. Outcomes included screw accuracy, surgery time, radiation exposure, and complications. A random-effects mean difference (MD) and odds ratio (OR) were used. After a comprehensive search, three studies were included. Two studies compared RA to FH, and one compared RA to navigation. Blood loss (MD -103.11 [-148.73, -57.49], p < 0.01) and radiation dose (MD -8.19 [-10.18, -6.19], p < 0.01) were lower in the RA group compared to FH. Operating time was significantly longer in the RA group compared to conventional methods (MD 36.55 [30.07, 43.04], p < 0.01). The number of correct screws (OR 2.15 [1.11, 4.15], p = 0.02) and satisfactory screws (OR 3.18 [1.13, 8.90], p = 0.03) was higher in the RA group. RA surgery provides significantly higher pedicle screw accuracy compared to FH and navigation methods, although at the cost of increased surgery time. Blood loss and radiation exposure were lower in the RA group compared to FH. While the results are promising, this meta-analysis included only three small trials. Future randomized controlled trials are needed to fully evaluate the effectiveness of RA surgery for AAD instrumentation.