Koucheki Robert, Bonello John-Peter, Abbas Aazad, Lex Johnathan, Versteeg Anne L, Zarrabian Mohammad, Dhaliwal Perry, Finkelstein Joel, Lewis Stephen, Toor Jay
Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Eur Spine J. 2025 Jun 25. doi: 10.1007/s00586-025-08990-y.
This meta-analysis compares prominent robotic platforms for spinal surgery, using conventional (freehand or fluoroscopy) and non-robotic navigation as common controls.
Literature searches were conducted using MEDLINE and EMBASE databases. Studies comparing screw placement of robot-assisted surgery with freehand/fluoroscopic or non-robotic navigation were included. Standard pairwise and network meta-analysis techniques with a random effects model (REM) were used with significance set at P < 0.05. Primary objective was to compare screw placement accuracy and breach incidence across robot platforms. Secondary objective was to compare neurologic complication (NC) rate and blood loss (BL) among platforms.
A total of 27 studies totaling 3404 patients were included. The robotic group demonstrated significantly fewer breaches compared to the conventional group (OR 0.54, P = 0.0004). The TiRobot (TINAVI) and Renaissance (Mazor) demonstrated the best overall accuracy. The robotic group demonstrated significantly lower NC (OR 0.3, P = 0.02) and lower BL (MD: - 112.74 mL, P = 0.002) compared to the conventional approach (freehand or fluoroscopy). Potential conflicts of interest and source bias were found in 60% of TiRobot and 30% of SpineAssist studies. Robotic surgery had significantly lower major breach rates compared to non-robotic navigation (OR 0.39, P = 0.04). The Mazor X model was superior between all robotic platforms, with an OR of 0.15 (95% CrI 0.01 to 0.69, P < 0.00001, I = 0%) for major breaches compared to non-robotic navigation.
Robot-assisted navigation platforms show significant reduction in breach rates compared to conventional and non-robotic navigation approaches in adult spinal instrumentation surgery. MazorX (Mazor), TiRobot (TINAVI) and Renaissance (Mazor) emerge as leaders in robotic spine surgery, each contributing to the increase efficacy. To obtain a more reliable evidence base guiding clinical practice and decision-making on the safety, efficacy, and superiority of specific robot-assisted navigation platforms in spinal surgery, further unbiased RCTs with international collaborations are needed.
本荟萃分析比较了用于脊柱手术的主要机器人平台，将传统（徒手或透视）和非机器人导航作为共同对照。
使用MEDLINE和EMBASE数据库进行文献检索。纳入比较机器人辅助手术与徒手/透视或非机器人导航下螺钉置入的研究。采用随机效应模型（REM）的标准成对和网络荟萃分析技术，显著性设定为P < 0.05。主要目的是比较不同机器人平台的螺钉置入准确性和突破发生率。次要目的是比较各平台之间的神经并发症（NC）发生率和失血量（BL）。
共纳入27项研究，总计3404例患者。与传统组相比，机器人组的突破明显更少（OR 0.54，P = 0.0004）。天玑机器人（天智航）和锐世（美敦力）表现出最佳的总体准确性。与传统方法（徒手或透视）相比，机器人组的NC明显更低（OR 0.3，P = 0.02），BL也更低（MD：-112.74 mL，P = 0.002）。在60%的天玑机器人研究和30%的脊柱助手研究中发现了潜在的利益冲突和来源偏倚。与非机器人导航相比，机器人手术的主要突破率显著更低（OR 0.39，P = 0.04）。在所有机器人平台中，美敦力X型号表现更优，与非机器人导航相比，主要突破的OR为0.15（95% CrI 0.01至0.69，P < 0.00001，I = 0%）。
在成人脊柱内固定手术中，与传统和非机器人导航方法相比，机器人辅助导航平台的突破率显著降低。美敦力X（美敦力）、天玑机器人（天智航）和锐世（美敦力）成为机器人脊柱手术的领先者，各自都提高了手术效果。为了获得更可靠的证据基础，以指导脊柱手术中特定机器人辅助导航平台的安全性、有效性和优越性的临床实践和决策，需要进一步开展具有国际合作性质的无偏倚随机对照试验。
