Effect of Robot-Assisted Surgery on Clinical Outcomes in Patients with Osteoporotic Vertebral Compression Fractures after Percutaneous Vertebral Augmentation: a Meta-Analysis and a Validation Cohort

Abstract

Background: The objective of this study was to investigate the impact of robot-assisted surgery (RA) on the risk of new vertebral compression fracture (NVCF) and bone cement leakage in patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous vertebral augmentation (PVA), including percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Methods: A meta-analysis was performed to evaluate the clinical outcomes and adverse effects of RA-PVA versus fluoroscopy-assisted (FA)-PVA in patients with OVCF. A validation cohort of 385 patients who underwent PVP or PKP was retrospectively analyzed. In addition, we attempted to create well-calibrated nomograms to estimate the risk of NVCF and bone cement leakage. Results: The meta-analysis revealed that the incidence of NVCF and bone cement leakage was significantly lower in RA-PVA than in FA-PVA. The validation cohort confirmed that RA-PVA provided better results than FA-PVA in terms of NVCF and bone cement leakage. Conclusions: The meta-analysis and the validation cohort suggest that RA reduced the risk of NVCF and bone cement leakage in patients with OVCF after PVA. The nomograms are accurate and easy-to-implement methods for clinicians to estimate the risk of NVCF and bone cement leakage after PVA.