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A systematic review and meta-analysis of perioperative parameters in robot-guided, navigated, and freehand thoracolumbar pedicle screw instrumentation
EANS Academy. Klukowska A. 09/26/19; 275922; EP12053
Ms. Anita M. Klukowska
Ms. Anita M. Klukowska

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Abstract
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Background: Robotic guidance (RG) and navigation (NV) have been shown to reduce radiological and clinically relevant pedicle screw malpositions. However, it remains unknown if there are any additional benefits to these techniques in intra- and perioperative endpoints.
Methods: We conducted a systematic review in MEDLINE, Embase, Scopus, and the Cochrane Library, and identified all controlled studies comparing RG, NV, and freehand (FH) thoracolumbar pedicle screw insertion, and carried out random-effects meta-analyses.
Results: Thirty-one studies (23'909 patients) were included. Only 1 relevant study comparing RG and NV was found. Only 8 (26%) studies were randomized. Generally, study quality was rated as low or very low in 24 cases (77%). Compared to NV, FH procedures demonstrated longer length of hospital stay (D: 0.7 days, 95% CI: 0.2 to 1.2, p=0.006) and more overall complications (OR: 1.6, 95% CI: 1.3 to 1.9, p< 0.001). No statistically significant differences among RG and FH were identified, likely due to lack in statistical power (all p>0.05). In particular, both RG and NV did not demonstrate increased intraoperative radiation usage, as determined by seconds of fluoroscopy, compared to FH (both p>0.05).
Conclusions: It appears that navigation may offer potential benefits in perioperative outcomes such as length of hospital stay and overall complications, without significant increase in intraoperative radiation, which cannot yet be said for robotic guidance. The current findings must be cautiously interpreted. Further evaluation will establish any demonstrable intra- or perioperative benefits to computer assistance, which may warrant the high costs often associated with these devices.
Background: Robotic guidance (RG) and navigation (NV) have been shown to reduce radiological and clinically relevant pedicle screw malpositions. However, it remains unknown if there are any additional benefits to these techniques in intra- and perioperative endpoints.
Methods: We conducted a systematic review in MEDLINE, Embase, Scopus, and the Cochrane Library, and identified all controlled studies comparing RG, NV, and freehand (FH) thoracolumbar pedicle screw insertion, and carried out random-effects meta-analyses.
Results: Thirty-one studies (23'909 patients) were included. Only 1 relevant study comparing RG and NV was found. Only 8 (26%) studies were randomized. Generally, study quality was rated as low or very low in 24 cases (77%). Compared to NV, FH procedures demonstrated longer length of hospital stay (D: 0.7 days, 95% CI: 0.2 to 1.2, p=0.006) and more overall complications (OR: 1.6, 95% CI: 1.3 to 1.9, p< 0.001). No statistically significant differences among RG and FH were identified, likely due to lack in statistical power (all p>0.05). In particular, both RG and NV did not demonstrate increased intraoperative radiation usage, as determined by seconds of fluoroscopy, compared to FH (both p>0.05).
Conclusions: It appears that navigation may offer potential benefits in perioperative outcomes such as length of hospital stay and overall complications, without significant increase in intraoperative radiation, which cannot yet be said for robotic guidance. The current findings must be cautiously interpreted. Further evaluation will establish any demonstrable intra- or perioperative benefits to computer assistance, which may warrant the high costs often associated with these devices.
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