Ogolo D E, Akwada O R, Ajare E C, Ndubuisi C A, Ohaegbulam S C
Division of Neurosurgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
Memfys Hospital for Neurosurgery, Enugu, Enugu State, Nigeria.
J Robot Surg. 2025 Aug 28;19(1):523. doi: 10.1007/s11701-025-02697-4.
Robotic-assisted spine surgery (RASS) has emerged as a potential advancement in spinal instrumentation, yet its comparative efficacy remains debated. This meta-analysis aimed to evaluate the accuracy, safety, and operative efficiency of RASS versus conventional freehand/navigation techniques, assess the impact of surgeon experience and robotic systems, and analyze secondary outcomes, such as complications and revision rates. A systematic review and meta-analysis followed PRISMA guidelines, incorporating 13 studies (5 RCTs, 3 prospective trials, 5 retrospective analyses) from PubMed, Embase, and other databases. Eligibility criteria included adult patients undergoing thoracolumbar/cervical pedicle screw placement. Primary outcomes were screw accuracy (Gertzbein-Robbins Grade A) and breach rates (> 2 mm); secondary outcomes included neurological injury, infection, revision surgery, and operative time. Data were analyzed using fixed/random-effects models, with subgroup analyses by pathology, robotic system, and surgeon experience. RASS demonstrated significantly higher perfect screw accuracy (94.2% vs. 85.1%; OR 2.41, p < 0.001) and lower breach rates (3.8% vs. 11.4%; OR 0.32, p < 0.001). Neurological injuries (1.9% vs. 4.3%; OR 0.45, p = 0.001) and revision surgeries (3.1% vs. 5.2%; OR 0.59, p = 0.02) were reduced, though operative times were longer (+ 12.4 min, p = 0.001). SSI rates showed a non-significant trend favouring RASS (2.5% vs. 3.7%; OR 0.67, p = 0.09). Subgroup analyses revealed greater benefits in deformity cases (OR 2.67), with Mazor systems (OR 2.55) and experienced surgeons (OR 4.55 after > 30 cases) achieving the best outcomes. RASS significantly improves screw accuracy and reduces complications compared to conventional techniques, particularly in complex cases and with surgeon proficiency. While operative times are marginally longer, the clinical benefits support its adoption, pending cost-effectiveness evaluations and individualized training programs.
机器人辅助脊柱手术（RASS）已成为脊柱器械领域一项颇具潜力的进展，但其相对疗效仍存在争议。本荟萃分析旨在评估RASS与传统徒手/导航技术相比的准确性、安全性和手术效率，评估外科医生经验和机器人系统的影响，并分析诸如并发症和翻修率等次要结局。一项系统评价和荟萃分析遵循PRISMA指南，纳入了来自PubMed、Embase和其他数据库的13项研究（5项随机对照试验、3项前瞻性试验、5项回顾性分析）。纳入标准包括接受胸腰椎/颈椎椎弓根螺钉置入的成年患者。主要结局为螺钉准确性（Gertzbein-Robbins A级）和突破率（>2毫米）；次要结局包括神经损伤、感染、翻修手术和手术时间。使用固定/随机效应模型分析数据，并按病理、机器人系统和外科医生经验进行亚组分析。RASS显示出显著更高的完美螺钉准确性（94.2%对85.1%；优势比2.41，p<0.001）和更低的突破率（3.8%对11.4%；优势比0.32，p<0.001）。神经损伤（1.9%对4.3%；优势比0.45，p = 0.001）和翻修手术（3.1%对5.2%；优势比0.59，p = 0.02）有所减少，不过手术时间更长（+12.4分钟，p = 0.001）。手术部位感染率显示出倾向于RASS的非显著趋势（2.5%对3.7%；优势比0.67，p = 0.09）。亚组分析显示在畸形病例中获益更大（优势比2.67），使用Mazor系统（优势比2.55）和经验丰富的外科医生（超过30例后优势比4.55）取得了最佳结局。与传统技术相比，RASS显著提高了螺钉准确性并减少了并发症，尤其是在复杂病例和外科医生熟练操作的情况下。虽然手术时间略长，但临床益处支持其应用，有待进行成本效益评估和个性化培训项目。
