Robotic-assisted pedicle screw placement fails to reduce overall postoperative complications in fusion surgery

Lieber, Alexander M.; Kirchner, Gregory J.; Kerbel, Yehuda E.; Khalsa, Amrit

doi:10.1016/j.spinee.2018.07.004

Cited by 44 publications

(48 citation statements)

References 20 publications

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“…Pedicle screw malposition always increases the rate of complication. The major screw-related complications including vascular or visceral damages, neurologic deficits, and cerebrospinal fluid leakage are identified [7]. More attention had been paid on neurologic deficits in previous experiments of free-hand screw insertion technique.…”

Section: Discussionmentioning

confidence: 99%

“…Although this method has been shown to be safe and used worldwide, screw misplacement rates vary greatly among previous research studies [2], [3], [4], [5], [6]. Malposition of the screw may result in severe surgical complications, such as vascular or visceral damage, neurological deficit, and dural tearing [3], [7]. To acquire higher accuracy in pedicle screw placement, several techniques have been introduced.…”

Section: Introductionmentioning

confidence: 99%

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A preliminary study of a novel robotic system for pedicle screw fixation: A randomised controlled trial

Chen

Zhu

et al. 2020

Journal of Orthopaedic Translation

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Background and objectiveExisting orthopaedic robotic systems are almost restricted to provide guidance for trajectory direction. In the present study, a novel spinal robotic system with automatic drilling power was introduced. The aim of this study is to evaluate the feasibility and safety in pedicle screw insertion of posterior lumbar interbody fusion assisted by this novel robotic system.Methods and materialsA randomised controlled trial was conducted for 17 participants who were required posterior lumbar interbody fusion process. Seven (3 M/4 F) were randomly assigned to the robot-assisted group (RA group), and the other ten (4 M/6 F) were assigned to the conventional technique group (FH group). A novel robotic system was used in the RA group. All measurements were based on postoperative computed tomography (CT) data. Accuracy of screw insertion was determined using the Gertzbein and Robbins Scale. Precision was measured by the entry point deviation distance and the trajectory rotation. Other variables included operation time, radiation time, length of stay, and screw-related complications.ResultA total of 82 pedicle screws were placed in the 17 participants. In the RA group, 90.6% of screws placed were Grade A, and 9.4% were Grade B. In the FH group, 78.0% of screws were Grade A, 20.0% were Grade B, and 2.0% were Grade C. No statistical difference was found in the operation time, radiation time per case, and length of stay between both groups. The radiation time per screw is significantly lower in the RA group. No screw-related complications or revision occurred in the present study.ConclusionThe outcome of screw accuracy of this robotic system was comparable with that of experienced surgeons, and no screw-related complication was found in the RA group during hospitalisation. In addition, radiation time per screw in the robotic group was significantly lower than that in the conventional group, which shows the potential to reduce radiation exposure of pedicle screw fixation assisted by this robotic system.Translational potentialOur study shows that pedicle screw fixation assisted by “Orthbot” system is accurate and safe. It is concluded that this novel robotic system offers a new option for internal implantation in spine surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A preliminary study of a novel robotic system for pedicle screw fixation: A randomised controlled trial

Chen

Zhu

et al. 2020

Journal of Orthopaedic Translation

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“…For complication rates, the overall comparison showed no significant difference between RA and FH groups (OR ¼ 0.57, 95% CI ¼ 0.28-1.15). However, the influence analysis showed that removing the study of Lieber and colleagues 5…”

Section: Complication Ratesmentioning

confidence: 99%

“…Other Fluoroscopy time [14][15][16][20][21][22][23][25][26][27]30,32 Egger's test 0.00 0.999 False Radiation dose [13][14][15][16]19,20,22,25,26,30,32 Egger's test À 0.59 0.572 False Operative time [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]30,32 Egger's test 0.32 0.753 False Length of hospital stay 5,[12][13][14][15][16][20][21][22]32 Egger's test À 2.20 0.052 False Complication rate…”

Section: Limitationsmentioning

confidence: 99%

“…Despite abundant evidence that robotic-assisted spine surgery has increased the accuracy of pedicle screw placement, whether it has improved the perioperative parameters is less clear. [3][4][5] Several studies compared robot-assisted (RA) and freehand (FH) techniques and reported conflicting results regarding patient outcomes such as complication rates, revision rates and length of stay. [6][7][8] Menger and colleagues analysed 1985 elective cases over 1 year and concluded that RA allowed more cases to shift to minimally invasive spine surgery (MIS) and resulted in fewer post-operative complications, less operative time and a shorter stay in hospital.…”

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confidence: 99%

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The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

Fang

Jin

et al. 2020

Robotics Computer Surgery

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Background: Medical robotics has enabled a significant advancement in the field of modern spine surgery, especially in pedicle screw fixation. A plethora of studies focused on the accuracy of pedicle fixation in robotic-assisted (RA) technology. However, it is not clear whether RA techniques can improve patients' clinical outcomes. Methods: We retrieved relevant studies that compare the differences between RA and freehand (FH) techniques in spine surgeries from the following databases: PubMed, Embase, Cochrane Library and Web of Science. The perioperative outcomes of this technology were measured with parameters including radiation exposure, operative time, the length of hospital stay, complication rates and revision rates. Two reviewers independently reviewed the studies in our sample, assessed their validity and extracted relevant data. Results: Our search resulted in a sample of 23 eligible studies, which involved 1247 patients (5042 pedicle screws) in the RA group and 1273 patients (4830 pedicle screws) in the FH group. With regard to the radiation exposure, the fluoroscopy time was less in surgeries assisted by Mazor robots (standard mean difference [SMD] ¼ À 0.96, 95% CI ¼ À 1.60 to À 0.31) but more in Tianji robots (SMD ¼ 0.91, 95% CI ¼ 0.17 to 1.66) and ROSA robots (SMD ¼ 2.57, 95% CI ¼ 2.01 to 3.13). For radiation dose, a decrease was observed in Tianji robots (SMD ¼ À 1.59, 95% CI ¼ À 2.13 to À 1.05). In the lumbar subgroup, the use of robots increased the operative time (SMD ¼ 0.53, 95% CI ¼ 0.19 to 0.86). In the degenerative diseases (DG) group, there was a significant decrease in the length of hospital stay when robots were introduced (SMD ¼ À 0.30, 95% CI ¼ À 0.48 to À 0.12). While in the DF (deformity) and DG group, a significant increase was found (SMD ¼ 0.17, 95% CI ¼ 0.02 to 0.32). The complication (OR ¼ 0.41, 95% CI ¼ 0.26 to 0.66) and the revision rates (OR ¼ 0.38, 95% CI ¼ 0.24 to 0.60) showed a significant decrease in the RA group compared to the conventional FH group. Conclusions: This study suggests that RA spine surgeries would result in fewer complications, a lower revision rate and shorter length of hospital stay. As the technology continues to evolve, we may expect more applications of robotic systems in spine surgeries. Junyu Li and Yanming Fang contributed equally to this work.

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A systematic review on the cost‐effectiveness of the computer‐assisted orthopedic system

Zhuang

et al. 2022

Health Care Science

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Computer‐assisted orthopedic system (CAOS) is rapidly gaining popularity in the field of precision medicine. However, the cost‐effectiveness of CAOS has not been well clarified. We performed this review to summarize and assess the cost‐effectiveness analyses (CEAs) with regard to CAOS. Publications on CEA in CAOS have been searched in PubMed and CEA Registry up to May 31, 2022. The Quality of Health Economic Studies (QHES) instrument was used to estimate the quality of studies. Relationships between qualities and potential factors were also examined. There were 15 eligible studies in the present review. Twelve studies evaluated CAOS joint arthroplasties and found that CAOS joint arthroplasties were cost‐effective compared to manual methods. Three studies focused on spinal surgery, two of which analyzed the cost‐effectiveness of CAOS for patients after spinal fusion, with conflicting results. One study demonstrated that CAOS was cost‐effective in spinal pedicle screw insertion. The mean QHES score of CEAs included was 86.1. The potential factors had no significant relationship with the quality of studies. Based on available studies, our review reflected that CAOS was cost‐effective in the field of joint arthroplasty. While in spinal surgery, the answer was unclear. Current CEAs represent high qualities, and more CEAs are required in the different disciplines of orthopedics where CAOS is employed.

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Robotic-assisted pedicle screw placement fails to reduce overall postoperative complications in fusion surgery

Cited by 44 publications

References 20 publications

A preliminary study of a novel robotic system for pedicle screw fixation: A randomised controlled trial

A preliminary study of a novel robotic system for pedicle screw fixation: A randomised controlled trial

The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

A systematic review on the cost‐effectiveness of the computer‐assisted orthopedic system

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