Robotic Pedicle Screw Placement: A Shortcut to Accurate Stabilization

Introduction: Incorrect placement of traditional freehand pedicle screws may result in dural rupture, nerve damage, and other issues. Robot-assisted pedicle screw insertion has significantly evolved in recent years. However, there were still uncertainty whether robot-assisted treatments are better than freehand approaches in terms of post-operative clinical outcomes. This metanalysis was conducted to compare the short-term clinical outcome between the robotic surgery and free hand screw placement technique. Methods: Systematic review was conducted with the Preferred Reporting Items of Systematic Reviews (PRISMA) guidelines with studies i from 2018 until 2023. All studies that compared the robotic surgery and freehand pedicle screw placement in spinal surgery will be included. Outcome parameters analyzed were Oswestry disability index (ODI), visual analog scale (VAS) score, duration of surgery, and intraoperative blood loss. Heterogeneity was assessed using I2 test, risk of bias was assessed using funnel plot, and analysis of comparison was done using the Review Manager Version 5.4. Results: Eight studies involved in this study with total samples of 2,381. Quantitative analysis showed VAS with MD=0.20 95%IC=0.16-0.23 p<0.00001, ODI with MD=4.92 95%IC=4.72-5.12 p<0.00001, duration of surgery with MD=1.73 95%IC=0.85-2.61 p=0.00001, intraoperative blood loss with MD=-8.83 95%IC=(-11.56)-(-6.10) p<0.00001). From the four parameters, it showed statistically significant differences but considerable heterogeneity. Conclusion: Robotic surgery gave better result in terms of VAS, ODI, duration of surgery, and intraoperative blood loss. However, this study still could not be applied extensively because of the considerable heterogeneity. Keywords: robotic spine surgery, pedicle screw placement, minimally invasive surgery