Robot-assisted Versus Conventional Pedicle Screw Instrumentation for Pediatric, Adolescent, and Young Adult Populations - Meta-analysis

Study Design. Systematic review with meta-analysis Objective. This meta-analysis aims to assess robotic and conventional surgical techniques for instrumentation of the spine among pediatric, adolescent, and young adult populations. Summary of Background Data. Spinal deformities among younger patients may be treated with pedicle screw instrumentation, however freehand guidance often leads to screw misplacements and consequent complications. Although computer-navigation surgery improved the screw accuracy, physiological limitations of the surgeon still remain a serious challenge. Robot-assisted (RA) surgery became a novel technique for enhancing screw accuracy. Methods. PRISMA and Cochrane Handbook were followed, and five databases were searched from inception. Studies analyzing patients aged up to 25 years old, and comparing RA to freehand or navigation were included. Outcomes included screw accuracy, perioperative outcomes, and complications. Meta-analysis was pooled with random-effects model. Results. Finally, 10 studies, 550 patients and 8061 screws were included in the meta-analysis. Accurate screw placement rates (Grade 0: OR 2.33, P <0.001) and clinically acceptable placements (Grade 0+1: OR 3.09, P <0.001) were significantly higher in robotic cohort. However, RA surgery increased operation time (MD 21.51 min, P =0.03). Blood loss, Cobb angle correction, hospital stay, or complications showed no significant differences between the two groups. Conclusions. RA surgery leads to improved accuracy of the pedicle scores, however this does not directly translate to better clinical or curvature outcomes. Moreover, longer operation times were observed in the robotic cohort. More high quality studies are needed to validate these findings.