Accuracy of pedicle screw placement comparing robot-assisted technology and the free-hand with fluoroscopy-guided method in spine surgery: An updated meta-analysis

BACKGROUND: A miniature spine-mounted robot has recently been introduced to further improve the accuracy of pedicle screw placement in spine surgery. However, the differences in accuracy between the robotic-assisted (RA) technique and the free-hand with fluoroscopy-guided (FH) method for pedicle screw placement are controversial. A meta-analysis was conducted to focus on this problem. METHODS: Several randomized controlled trials (RCTs) and cohort studies involving RA and FH and published before January 2017 were searched for using the Cochrane Library, Ovid, Web of Science, PubMed, and EMBASE databases. A total of 55 papers were selected. After the full-text assessment, 45 clinical trials were excluded. The final meta-analysis included 10 articles. RESULTS: The accuracy of pedicle screw placement within the RA group was significantly greater than the accuracy within the FH group (odds ratio 95%, “perfect accuracy” confidence interval: 1.38–2.07, P < .01; odds ratio 95% “clinically acceptable” Confidence Interval: 1.17–2.08, P < .01). CONCLUSIONS: There are significant differences in accuracy between RA surgery and FH surgery. It was demonstrated that the RA technique is superior to the conventional method in terms of the accuracy of pedicle screw placement.