Comparison Of Cranial Facet Joint Violation Rate Between Robot-assisted Percutaneous And Conventional Freehand Pedicle Screw Placement In Spine Surgery: A Meta-analysis

Objective Cranial facet joint violation(FJV)is an important risk factor for adjacent segment degeneration.Some studies recommended the use of robot-assisted(RA)pedicle screw placement in reducing the rate of cranial FJV instead of conventional freehand(FH)pedicle screw placement.However,the superiority of RA techniques to FH techniques remains controversial.Through meta-analysis,whether RA techniques are superior to conventional FH techniques was determined in terms of cranial facet joint protection and four other clinical indexes,namely,the accuracy of pedicle screw placement,the number of surgical revision due to malposition,intraoperative radiation dose,and operative time.Methods A comprehensive search on Pub Med,EMBASE,Cochrane,Web of Science,CNKI,and Wan Fang was conducted for the selection of potential eligible literature.The outcomes were evaluated in terms of odds ratio(OR)or mean difference(MD)and corresponding 95%confidence interval(CI).The meta-analysis was conducted using Rev Man 5.3.The subgroup analyses of the violation of the cranial facet joint and the accuracy of pedicle screw placement were performed on the basis of robot type.Result Three randomized controlled trials,two prospective cohort study,and one retrospective cohort study consisting of 783 patients and 2694 cranial pedicle screws were included in the meta-analysis.RA pedicle screw placement was associated with significantly fewer cranial FJVs than FH screw placement(OR=0.19,95%CI=0.11-0.34,P<0.01,I~2=0%).Subgroup analyses showed that the Renaissance(OR=0.19,95%CI=0.07–0.56,P<0.01,I~2=35%)and TINAVI(OR=0.19,95%CI=0.09–0.38,P<0.01,I~2=0%)robots under RA techniques were associated with significantly fewer cranial FJVs than FH techniques.Moreover,RA pedicle screw placement was associated with significantly higher rate of pedicle screw placement accuracy than FH screw placement(OR=0.24,95%CI=0.14–0.43,P<0.01,I~2=0%).Subgroup analyses showed that Renaissance robot under RA techniques was associated with similar rate of pedicle screw placement accuracy to rate of pedicle screw placement accuracy(OR=0.46,95%CI=0.07–3.14,P=0.43,I~2=0%),whereas TINAVI robots under RA techniques were associated with higher rate of pedicle screw placement accuracy than FH screw placement(OR=0.23,95%CI=0.13–0.42,P<0.01,I~2=0%).Furthermore,the RA techniques showed lower intraoperative radiation dose(MD=-39.23,95%CI=-53.86 to-24.60,P<0.01,I~2=87%)but longer operative time(MD=14.27,95%CI=5.79–22.75,P<0.01,I~2=0%)and equivalent number of surgical revision due to malposition(OR=0.25,95%CI=0.05–1.20,P=0.08,I~2=0%)than the FH techniques.Conclusion The RA(Renaissance and TINAVI)techniques are superior to conventional FH techniques in terms of protecting the cranial facet joint.Thus,RA techniques are accurate and safe in clinical application.