A Comparison of Spinal Robotic Systems and Pedicle Screw Accuracy Rates: Review of Literature and Meta-Analysis

Abstract

Introduction The motivation to improve accuracy and reduce complication rates in spinal surgery has driven great advancements in robotic surgical systems, with the primary difference between the newer generation and older generation models being the presence of an optical camera and multijointed arm. This study compares accuracy and complication rates of pedicle screw placement in older versus newer generation robotic systems reported in the literature. Methods We performed a systemic review and meta-analysis describing outcomes of pedicle screw placement with robotic spine surgery. We assessed the robustness of these findings by quantifying levels of cross-study heterogeneity and publication bias. Finally, we performed meta-regression to test for associations between pedicle screw accuracy and older versus newer generation robotic spine system usage. Results Average pedicle screw placement accuracy rates for old and new generation robotic platforms were 97 and 99%, respectively. Use of new generation robots was significantly associated with improved pedicle screw placement accuracy (p = 0.03). Conclusion Accuracy of pedicle screw placement was high across all generations of robotic surgical systems. However, newer generation robots were shown to be significantly associated with accurate pedicle screw placement, showing the benefits of upgrading robotic systems with a real-time optical camera and multijointed arm.

Preoperative Robotics Planning Facilitates Complex Construct Design in Robot-Assisted Minimally Invasive Adult Spinal Deformity Surgery—A Preliminary Experience

“…While the use of robotics systems has been described for the treatment of adult spinal deformity, the vast majority of these have been for open surgery or descriptions of S2-alar-iliac screw placement [24]. MIS placement of screws in short-segment degenerative pathologies has also been well reported [15,27,28], but their use for long-segment complex deformity correction has been described less frequently. Our series herein thereby serves to illustrate that long-segment constructs can be designed for MIS correction of ASD.…”

Ultrasound-Based Robot-Assisted Drilling for Minimally Invasive Pedicle Screw Placement

“…Li et al performed a meta-analysis that shows that robot-assisted system interventions achieved an 88.9% grade A according to the GR classification, compared to 84.0% for freehand screw placement [23]. Additionally, the learning curve for robotassisted PSP is reported to be significantly shorter than that of the manual technique [24].…”

Utility of a Navigated High-Speed Drill in Robotic-Assisted Screw Placement for Spine Surgery

“…According to a systematic review in 2017, the accuracy of the early models (SpineAssist, Renaissance, ROSA robot) ranged from 85% to 100% [ 2 ]. Moreover, a meta-analysis reported in 2022 showed that the accuracy of the older generation models (SpineAssist, Renaissance) was 97%, while the newer generation models (Mazor X, Excelsius GPS, ROSA Spine, TINAVI) exhibited an accuracy of 99%, indicating that the newer models were more precise [ 3 ].…”