Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 576-587.e5 |
| Journal | World Neurosurgery |
| Volume | 127 |
| DOIs | |
| Publication status | Published - 2019 |
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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 journal › Review article › Academic › peer-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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85064943676&origin=inward
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
ER -