Łajczak Paweł, Sahin Oguz K, Sharma Eshita, Ayesha Ayesha, Łajczak Anna
Medical University of Silesia, Katowice, Poland.
Edremit State Hospital, Balikesir, Turkey.
World Neurosurg. 2025 Jul;199:124109. doi: 10.1016/j.wneu.2025.124109. Epub 2025 May 23.
Robotic-assisted minimally invasive surgery (RA-MIS) is becoming increasingly applied to spinal surgery, offering an alternative to conventional minimally invasive spinal surgery (C-MIS). Recently, RA-MIS has been proposed for pedicle screw instrumentation in thoracolumbar fractures. This review aims to evaluate RA-MIS and C-MIS among the thoracolumbar fracture population.
This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines. 5 medical databases were searched. Finally, 10 studies were included in the meta-analysis, with a total of 562 patients. Outcomes on operation time, blood loss, pedicle screw accuracy, complications, and cost-effectiveness were evaluated.
RA-MIS showed superiority in terms of accurate (Gertzbein and Robbins [GR] A) screw placement (odds ratio [OR]: 3.58, 95% confidence interval [CI]: 2.30-5.58, P < 0.001) and satisfactory (GR A+B) screw placement (OR: 3.86, 95% CI: 2.14-6.96, P < 0.001) compared to C-MIS. RA-MIS led to a significantly lower incidence of severely misplaced (GR D+E) screws (OR: 0.26, 95% CI: 0.13-0.51, P < 0.001) and lower blood loss (mean difference [MD]: -12.03, 95% CI: -20.85 to -3.21, P < 0.01). However, we found no statistically significant differences in operation time (MD: -4.92, 95% CI: -12.06 to 2.22, P = 0.18) or complications (screw loosening, nerve injury, or infection). Costs of RA-MIS were significantly higher (MD: ¥8657.61, 95% CI: 6651.39 to 10,663.83, P < 0.01).
Robotic-assisted minimally invasive spinal surgery is superior in terms of higher pedicle screw accuracy and reduced perioperative blood loss, at the cost of significantly higher costs of surgery. Furthermore, we observed no clear advantages regarding complication rate and total operation time. Future trials should provide a less biased methodology to confirm the findings.
机器人辅助微创手术（RA-MIS）在脊柱手术中的应用越来越广泛，为传统微创脊柱手术（C-MIS）提供了一种替代方案。最近，RA-MIS已被用于胸腰椎骨折的椎弓根螺钉内固定术。本综述旨在评估胸腰椎骨折患者中RA-MIS和C-MIS的效果。
本研究遵循系统评价和Meta分析的首选报告项目以及Cochrane指南。检索了5个医学数据库。最终，10项研究纳入Meta分析，共562例患者。评估了手术时间、失血量、椎弓根螺钉置入准确性、并发症及成本效益等结果。
与C-MIS相比，RA-MIS在准确（Gertzbein和Robbins [GR] A级）螺钉置入方面具有优势（优势比[OR]：3.58，95%置信区间[CI]：2.30-5.58，P<0.001），在满意（GR A+B级）螺钉置入方面也具有优势（OR：3.86，95%CI：2.14-6.96，P<0.001）。RA-MIS导致严重误置（GR D+E级）螺钉的发生率显著降低（OR：0.26，95%CI：0.13-0.51，P<你提供的原文此处有误，正确应为P<0.001），失血量也更低（平均差[MD]：-12.03，95%CI：-20.85至-3.21，P<0.01）。然而，我们发现手术时间（MD：-4.92，95%CI：-12.06至2.22）或并发症（螺钉松动、神经损伤或感染）方面无统计学显著差异。RA-MIS的成本显著更高（MD：8657.61元，95%CI：6651.39至10663.83元，P<0.01）。
机器人辅助微创脊柱手术在椎弓根螺钉置入准确性更高和围手术期失血量减少方面具有优势，但手术成本显著更高。此外，我们未观察到在并发症发生率和总手术时间方面有明显优势。未来的试验应提供偏差较小的方法来证实这些发现。
