Comparison of the accuracy between robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis

To perform a systematic review and meta-analysis to investigate the different of accuracy between robot-assisted and conventional freehand pedicle screw placement.

The electronic databases of PubMed, Ovid MEDLINE, EMBASE, and Web of Science were searched for the literatures published up to January, 2016. Statistical analysis was performed using the Review Manager 5.3. The dichotomous data for the pedicle violation rate were summarized using relative risk (RR) and 95 % confidence intervals (CIs). The level of significance was set at \(P<0.05\).

A total of 257 patients and 1105 screws were included in the five studies for this meta-analysis. The results revealed that there was no difference in the accuracy between robot-assisted and conventional freehand pedicle screw placement at the 0 mm grading criteria (RR 1.08, 95 % CI 0.86, 1.35, \(I^{2}=28\,\%\), \(P=0.52\)) and at 2 mm grading criteria (RR 1.02, 95 % CI 0.68, 1.51, \({I}^{2}=28\,\%\), \(P=0.93\)). Among percutaneous robot-assisted technique, open robot-assisted technique and conventional freehand technique, there was also no significant difference at 0mm grading criteria (RO(P) vs FH : RR 1.10, 95 % CI 0.87, 1.40, \(I^{2}=34\,\%\), \(P=0.43\); RO(O) versus FH : RR 0.87, 95 % CI 0.55, 1.38, \(\mathrm{I}^{2}=9\,\%\), \(P=0.55\); RO(P) vs RO(O): RR 1.20, 95 % CI 0.65, 2.24, \(P=0.56\)) and at 2 mm grading criteria(RO(P) vs FH : RR 1.07, 95 % CI 0.43, 2.67, \( I^{2}=55\,\%\), \(P=0.88\); RO(O) vs FH : RR 0.71, 95 % CI 0.36, 1.39, \(I^{2}=0\,\%\), \(P=0.32\); RO(P) vs RO(O) : RR 0.84, 95 % CI 0.36, 1.94, \(P=0.68\)).

Further high-quality studies are required to unequivocally recommend one surgical technique over the other. With the more application of robot-assisted navigation system, accuracy and clinical benefit of the technique will be gradually improved.