Comparison of robot versus fluoroscopy-assisted pedicle screw instrumentation in adolescent idiopathic scoliosis surgery: a Meta-analysis

摘要

AIM: To investigate the safety and accuracy of robot-assisted pedicle screw placement in adolescent idiopathic scoliosis (AIS) surgery. METHODS: PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for studies utilizing the clinical data of adolescent idiopathic scoliosis patients (robot-assisted and fluoroscopy-assisted group) who underwent posterior pedicle screw fixation to collect preoperative, postoperative and follow-up indexes and imaging parameters, including screw implantation accuracy, the number of intraoperative fluoroscopy times, amount of bleeding, operation time, postoperative VAS score and postoperative Cobb angle. RESULTS: Six studies were included in this meta-analysis, including 154 patients in the intervention group and 171 patients in the control group. Our results showed that screw implantation accuracy (WMD 1.07, 95% CI (1.01,1.14), P = 0.03) was higher than that in the control group. The number of intraoperative fluoroscopy times (WMD -6.11, 95% CI (-9.60, -2.62), P = 0.0006) and operation time (WMD 31.52, 95% CI (5.70,57.35), P = 0.02) in the robot group were less, and the differences were statistically significant. Intraoperative blood (WMD -59.05, 95% CI (-212.81,94.70), P = 0.45), postoperative VAS score (WMD -0.07, 95% CI (-0.24,0.11), P = 0.46), preoperative Cobb angle (WMD 0.79, 95% CI (-1.12,2.69), P = 0.42) (Fig. 7), postoperative Cobb angle (WMD -0.25, 95% CI (-1.12,0.62), P = 0.57) (Fig. 8) had no statistical significance in the robot group compared with control group. CONCLUSION: The robot navigation system can improve screw implantation accuracy and reduce the operation time and radiation exposure during the operation.