Comparison of accuracy and safety between robot-assisted and conventional fluoroscope assisted placement of pedicle screws in thoracolumbar spine

Li, Chuntao; Li, Wenyi; Gao, Shangju; Cao, Can; Li, Changren; He, Liang; Ma, Xu; Li, Meng

doi:10.1097/md.0000000000027282

Cited by 11 publications

(9 citation statements)

References 34 publications

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“…In accordance with previous reports [ 5 , 6 , 35 ], the result of the direct meta-analysis ((RR = 1.07, 95% CI 1.04–1.11)) confirms that the robot-assisted method is superior to the conventional technique in accuracy. Moreover, further subgroup analysis by the type of robot device shows the main positive effect is original from the subgroup of TiRobot (RR = 1.11, 95% CI 1.07–1.16).…”

Section: Discussionsupporting

confidence: 91%

Accuracies of various types of spinal robot in robot-assisted pedicle screw insertion: a Bayesian network meta-analysis

et al. 2023

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Background With the popularization of robot-assisted spinal surgeries, it is still uncertain whether robots with different designs could lead to different results in the accuracy of pedicle screw placement. This study aimed to compare the pedicle screw inserting accuracies among the spinal surgeries assisted by various types of robot and estimate the rank probability of each robot-assisted operative technique involved. Methods The electronic literature database of PubMed, Web of Science, EMBASE, CNKI, WANFANG and the Cochrane Library was searched in November 2021. The primary outcome was the Gertzbein–Robbins classification of pedicle screws inserted with various operative techniques. After the data extraction and direct meta-analysis process, a network model was established in the Bayesian framework and further analyses were carried out. Results Among all the 15 eligible RCTs, 4 types of robot device, namely Orthbot, Renaissance, SpineAssist and TiRobot, were included in this study. In the network meta-analysis, the Orthbot group (RR 0.27, 95% CI 0.13–0.58), the Renaissance group (RR 0.33, 95% CI 0.14–0.86), the SpineAssist group (RR 0.14, 95% CI 0.06–0.34) and the conventional surgery group (RR 0.21, 95% CI 0.13–0.31) were inferior to the TiRobot group in the proportion of grade A pedicle screws. Moreover, the results of rank probabilities revealed that in terms of accuracy, the highest-ranked robot was TiRobot, followed by Renaissance and Orthbot. Conclusions In general, current RCT evidence indicates that TiRobot has an advantage in the accuracy of the pedicle screw placement, while there is no significant difference among the Orthbot-assisted technique, the Renaissance-assisted technique, the conventional freehand technique, and the SpineAssist-assisted technique in accuracy.

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Section: Discussionsupporting

confidence: 91%

Accuracies of various types of spinal robot in robot-assisted pedicle screw insertion: a Bayesian network meta-analysis

et al. 2023

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“…Recent studies and meta-analysis have shown the superior accuracy of navigated, intraoperative spinal instrumentation compared to non-navigated techniques [30][31][32][33][34][35][36]. Particularly for safe and reliable S2AIS and tricortical S1 pedicle screw insertion, real-time spinal navigation is becoming increasingly attractive considering the complex anatomical considerations of biomechanically superior screw insertion across multiple cortices in the sacral and iliac bone.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative imaging and navigated spinopelvic instrumentation: S2-alar-iliac screws combined with tricortical S1 pedicle screw fixation

Sargut

Hecht

et al. 2022

Eur Spine J

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Purpose The present study aimed to assess the feasibility, safety and accuracy of navigated spinopelvic fixation with focus on S2-alar-iliac screws (S2AIS) and tricortical S1 pedicle screw implantation with the use of high-resolution three-dimensional intraoperative imaging and real-time spinal navigation. Methods Patients undergoing navigated intraoperative CT-based spinopelvic stabilization between January 2016 and September 2019 were included. Pelvic fixation was achieved by implantation of S2AIS or iliac screws (IS). S1 screws were implanted with the goal of achieving tricortical purchase. In all cases, instrumentation was performed with real-time spinal navigation and intraoperative screw positioning was assessed using intraoperative computed tomography (iCT), cone-beam CT (CBCT) and robotic cone-beam CT (rCBCT). Screw accuracy was evaluated based on radiographic criteria. To identify predictors of complications, univariate analysis was performed. Results Overall, 52 patients (85%) received S2AIS and nine patients (15%) received IS instrumentation. Intraoperative imaging and spinal navigation were performed with iCT in 34 patients, CBCT in 21 patients and rCBCT in six patients. A total number of 10/128 (7.8%) iliac screws underwent successful intraoperative correction due to misalignment. Tricortical purchase was successfully accomplished in 58/110 (53%) of the S1 screws with a clear learning curve in the course of time. S2AIS implantation was associated with significantly fewer surgical side infection-associated surgeries. Conclusions Real-time navigation facilitated spinopelvic instrumentation with increasing accuracy of S2AIS and tricortical S1 screws. Intraoperative imaging by iCT, CBCT or rCBCT permitted screw assessment with the chance of direct navigated revision of misplaced iliac screws to avoid secondary screw revision surgery.

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“…Several systematic reviews have found that robotic-assisted spine fusion surgery was associated with statistically significant improvements in accuracy of pedicle screw placement and lower rates of revision surgery than conventional fluoroscopy-assisted placement or freehand techniques. 16,[38][39][40] Also, emerging evidence suggests that robot-assisted pedicle screw placement results in significant reductions in perioperative complications, such as blood loss. 16 However, there is some evidence that indicates that the clinical outcomes and complications following robot-assisted pedicle screw placement are not significantly different from those of conventional techniques.…”

Section: Spinal Surgeriesmentioning

confidence: 99%

“…16 However, there is some evidence that indicates that the clinical outcomes and complications following robot-assisted pedicle screw placement are not significantly different from those of conventional techniques. 39,40 Contradictory evidence exists around whether robotic-assisted spine surgeries are associated with reduced radiation exposure through shorter intraoperative radiation time and fewer radiation dose than with conventional techniques. 16,38,39 Economic Considerations…”

Section: Spinal Surgeriesmentioning

confidence: 99%

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Robotic Surgical Systems for Orthopedics

Smith¹,

Picheca²,

Mahood³

2022

cjht

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Robotic surgical systems for orthopedics are used primarily in procedures to treat osteoarthritis (either partial or full knee replacement or total hip replacement), and in procedures to treat degenerative spinal disease or spinal alignment or curvature abnormalities. Robotic-assisted orthopedic surgeries are intended to improve the accuracy and precision of implant placement and may lead to improved clinical outcomes, shorter recovery time, and fewer revisions. Evidence around their clinical effectiveness is still limited, however, the trend suggests that robot-assisted surgeries may be comparable, or marginally better, in clinical effectiveness when compared to conventional techniques. Robotic-assisted surgery can reduce the length of inpatient stay, but it involves longer operative times. Larger, long-term, randomized controlled trials are needed to confirm their comparative effectiveness. Robotic surgical systems for orthopedics are costly because their initial capital purchase is high, and each procedure requires the use of consumables. However, they may reduce length of stay, which can free up inpatient beds, and reduce rates of revision, which can be cost saving. While some evidence suggests that robotic-assisted knee and hip replacements can be cost-effective, there is limited cost-effectiveness information specific to Canadian contexts. There is a steep learning curve to adopting robotic surgical systems and teams require training and ongoing technical support to ensure that the unit is used to its full capacity. The roles of team members, particularly nursing staff, may change and require advanced technical knowledge. Robotic surgical systems are constantly evolving, integrating new and improved components such as augmented reality, artificial intelligence, digital imaging, and computer-assisted navigation. There will likely be many changes and refinements to these technologies over the coming years.

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Comparison of accuracy and safety between robot-assisted and conventional fluoroscope assisted placement of pedicle screws in thoracolumbar spine

Cited by 11 publications

References 34 publications

Accuracies of various types of spinal robot in robot-assisted pedicle screw insertion: a Bayesian network meta-analysis

Accuracies of various types of spinal robot in robot-assisted pedicle screw insertion: a Bayesian network meta-analysis

Intraoperative imaging and navigated spinopelvic instrumentation: S2-alar-iliac screws combined with tricortical S1 pedicle screw fixation

Robotic Surgical Systems for Orthopedics

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