A Systematic Review and Meta-Analysis of Perioperative Parameters in Robot-Guided, Navigated, and Freehand Thoracolumbar Pedicle Screw Instrumentation

Alessandro Siccoli, Anita M. Klukowska, Marc L. Schröder, Victor E. Staartjes

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Background: Robotic guidance (RG) and navigation (NV) have been shown to reduce radiologic and clinically relevant pedicle screw malpositions. It remains unknown if there are any additional benefits to these techniques in intraoperative and perioperative end points. Methods: We conducted a systematic review in MEDLINE, Embase, Scopus, and the Cochrane Library and identified controlled studies comparing RG, NV, and freehand (FH) thoracolumbar pedicle screw insertion and carried out random-effects meta-analyses. Results: Thirty-two studies (24,008 patients) were included. Only 8 studies (26%) were randomized, and study quality was rated as very low or low in 24 cases (77%). Compared with NV, FH procedures showed longer length of hospital stay (Δ, 0.7 days; 95% confidence interval, 0.2–1.2; P = 0.006) and more overall complications (odds ratio, 1.6; 95% confidence interval, 1.3–1.9; P < 0.001). No statistically significant differences among RG and FH were identified, likely because of lack in statistical power (all P > 0.05). In particular, both RG and NV did not show increased intraoperative radiation use, as determined by seconds of fluoroscopy, compared with FH (both P > 0.05). Conclusions: It seems 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 findings must be interpreted with caution, because the evidence is severely limited in both quantity and quality. Further evaluation will establish any demonstrable intraoperative or perioperative benefits to computer assistance, which may warrant the high costs often associated with these devices.
Original languageEnglish
Pages (from-to)576-587.e5
JournalWorld Neurosurgery
Volume127
DOIs
Publication statusPublished - 2019

Cite this

Siccoli, Alessandro ; Klukowska, Anita M. ; Schröder, Marc L. ; Staartjes, Victor E. / A Systematic Review and Meta-Analysis of Perioperative Parameters in Robot-Guided, Navigated, and Freehand Thoracolumbar Pedicle Screw Instrumentation. In: World Neurosurgery. 2019 ; Vol. 127. pp. 576-587.e5.
@article{484aea1f243c41059fe9964a980b962f,
title = "A Systematic Review and Meta-Analysis of Perioperative Parameters in Robot-Guided, Navigated, and Freehand Thoracolumbar Pedicle Screw Instrumentation",
abstract = "Background: Robotic guidance (RG) and navigation (NV) have been shown to reduce radiologic and clinically relevant pedicle screw malpositions. It remains unknown if there are any additional benefits to these techniques in intraoperative and perioperative end points. Methods: We conducted a systematic review in MEDLINE, Embase, Scopus, and the Cochrane Library and identified controlled studies comparing RG, NV, and freehand (FH) thoracolumbar pedicle screw insertion and carried out random-effects meta-analyses. Results: Thirty-two studies (24,008 patients) were included. Only 8 studies (26{\%}) were randomized, and study quality was rated as very low or low in 24 cases (77{\%}). Compared with NV, FH procedures showed longer length of hospital stay (Δ, 0.7 days; 95{\%} confidence interval, 0.2–1.2; P = 0.006) and more overall complications (odds ratio, 1.6; 95{\%} confidence interval, 1.3–1.9; P < 0.001). No statistically significant differences among RG and FH were identified, likely because of lack in statistical power (all P > 0.05). In particular, both RG and NV did not show increased intraoperative radiation use, as determined by seconds of fluoroscopy, compared with FH (both P > 0.05). Conclusions: It seems 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 findings must be interpreted with caution, because the evidence is severely limited in both quantity and quality. Further evaluation will establish any demonstrable intraoperative or perioperative benefits to computer assistance, which may warrant the high costs often associated with these devices.",
author = "Alessandro Siccoli and Klukowska, {Anita M.} and Schr{\"o}der, {Marc L.} and Staartjes, {Victor E.}",
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A Systematic Review and Meta-Analysis of Perioperative Parameters in Robot-Guided, Navigated, and Freehand Thoracolumbar Pedicle Screw Instrumentation. / Siccoli, Alessandro; Klukowska, Anita M.; Schröder, Marc L.; Staartjes, Victor E.

In: World Neurosurgery, Vol. 127, 2019, p. 576-587.e5.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - A Systematic Review and Meta-Analysis of Perioperative Parameters in Robot-Guided, Navigated, and Freehand Thoracolumbar Pedicle Screw Instrumentation

AU - Siccoli, Alessandro

AU - Klukowska, Anita M.

AU - Schröder, Marc L.

AU - Staartjes, Victor E.

PY - 2019

Y1 - 2019

N2 - Background: Robotic guidance (RG) and navigation (NV) have been shown to reduce radiologic and clinically relevant pedicle screw malpositions. It remains unknown if there are any additional benefits to these techniques in intraoperative and perioperative end points. Methods: We conducted a systematic review in MEDLINE, Embase, Scopus, and the Cochrane Library and identified controlled studies comparing RG, NV, and freehand (FH) thoracolumbar pedicle screw insertion and carried out random-effects meta-analyses. Results: Thirty-two studies (24,008 patients) were included. Only 8 studies (26%) were randomized, and study quality was rated as very low or low in 24 cases (77%). Compared with NV, FH procedures showed longer length of hospital stay (Δ, 0.7 days; 95% confidence interval, 0.2–1.2; P = 0.006) and more overall complications (odds ratio, 1.6; 95% confidence interval, 1.3–1.9; P < 0.001). No statistically significant differences among RG and FH were identified, likely because of lack in statistical power (all P > 0.05). In particular, both RG and NV did not show increased intraoperative radiation use, as determined by seconds of fluoroscopy, compared with FH (both P > 0.05). Conclusions: It seems 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 findings must be interpreted with caution, because the evidence is severely limited in both quantity and quality. Further evaluation will establish any demonstrable intraoperative or perioperative benefits to computer assistance, which may warrant the high costs often associated with these devices.

AB - Background: Robotic guidance (RG) and navigation (NV) have been shown to reduce radiologic and clinically relevant pedicle screw malpositions. It remains unknown if there are any additional benefits to these techniques in intraoperative and perioperative end points. Methods: We conducted a systematic review in MEDLINE, Embase, Scopus, and the Cochrane Library and identified controlled studies comparing RG, NV, and freehand (FH) thoracolumbar pedicle screw insertion and carried out random-effects meta-analyses. Results: Thirty-two studies (24,008 patients) were included. Only 8 studies (26%) were randomized, and study quality was rated as very low or low in 24 cases (77%). Compared with NV, FH procedures showed longer length of hospital stay (Δ, 0.7 days; 95% confidence interval, 0.2–1.2; P = 0.006) and more overall complications (odds ratio, 1.6; 95% confidence interval, 1.3–1.9; P < 0.001). No statistically significant differences among RG and FH were identified, likely because of lack in statistical power (all P > 0.05). In particular, both RG and NV did not show increased intraoperative radiation use, as determined by seconds of fluoroscopy, compared with FH (both P > 0.05). Conclusions: It seems 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 findings must be interpreted with caution, because the evidence is severely limited in both quantity and quality. Further evaluation will establish any demonstrable intraoperative or perioperative benefits to computer assistance, which may warrant the high costs often associated with these devices.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30954747

U2 - 10.1016/j.wneu.2019.03.196

DO - 10.1016/j.wneu.2019.03.196

M3 - Review article

VL - 127

SP - 576-587.e5

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

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