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Bony fixation in the era of spinal robotics: A systematic review and meta-analysis

Himstead, Alexander S. and Shahrestani, Shane and Brown, Nolan J. and Produturi, Gautam and Shlobin, Nathan A. and Al Jammal, Omar and Choi, Elliot H. and Ransom, Seth C. and Diaz-Aguilar, Luis Daniel and Sahyouni, Ronald and Abraham, Mickey and Pham, Martin H. (2022) Bony fixation in the era of spinal robotics: A systematic review and meta-analysis. Journal of Clinical Neuroscience, 97 . pp. 62-74. ISSN 0967-5868. doi:10.1016/j.jocn.2022.01.005.

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Background. Accurate spinal screw placement in spinal instrumentation is of utmost importance to avoid injury to surrounding neurovascular structures. This study was performed to investigate differences in accuracy, operating room time, length of stay, and operative blood loss across studies involving all types of spinal fixation. Methods. PubMed, EMBASE, and Scopus were systematically queried to identify articles that fit the inclusion and exclusion criteria. Meta-analysis was performed using R software, and odds ratios and 95% CIs were calculated. Results. Sixty-nine articles were included in qualitative synthesis, and 35 studies in the meta-analysis, for a total of 8,174 robotically placed screws in 1,492 patients compared to 9,791 conventionally placed screws in 1,638 patients. A total of 9 screw trajectories were studied in the literature, although only 4 had enough evidence to be included in the meta-analysis. Robotic screw placement was more accurate than conventional screw placement (OR 2.24; 95% CI, 1.71–2.94). Robotic placement was not associated with significantly different postoperative length of stay (SMD −0.32; 95% CI, −1.20, 0.51), operative blood loss (SMD −0.25; 95% CI, −0.79, 0.19), or operative duration (SMD 0.08; 95% CI −1.00, 1.39). A total of 8 robotic platforms were found in the literature with accuracy rates above 93%. Conclusion. Robotic spinal fixation is associated with increased screw placement accuracy and similar operative blood loss, length of stay, and operative duration. These findings support the safety and cost-effectiveness of robotic spinal surgery across the spectrum of robotic systems and screw types.

Item Type:Article
Related URLs:
URLURL TypeDescription
Himstead, Alexander S.0000-0001-9244-700X
Shahrestani, Shane0000-0001-7561-4590
Brown, Nolan J.0000-0002-6025-346X
Shlobin, Nathan A.0000-0003-2079-6125
Al Jammal, Omar0000-0001-6439-3526
Choi, Elliot H.0000-0001-8762-5473
Ransom, Seth C.0000-0001-5949-1703
Sahyouni, Ronald0000-0002-2124-0535
Abraham, Mickey0000-0002-6223-9610
Pham, Martin H.0000-0002-7733-8902
Additional Information:© 2022 Elsevier. Received 2 October 2021, Accepted 8 January 2022, Available online 19 January 2022, Version of Record 19 January 2022. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Record Number:CaltechAUTHORS:20220513-557980000
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Official Citation:Alexander S. Himstead, Shane Shahrestani, Nolan J. Brown, Gautam Produturi, Nathan A. Shlobin, Omar Al Jammal, Elliot H. Choi, Seth C. Ransom, Luis Daniel Diaz-Aguilar, Ronald Sahyouni, Mickey Abraham, Martin H. Pham, Bony fixation in the era of spinal robotics: A systematic review and meta-analysis, Journal of Clinical Neuroscience, Volume 97, 2022, Pages 62-74, ISSN 0967-5868,
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:114749
Deposited By: George Porter
Deposited On:13 May 2022 22:11
Last Modified:13 May 2022 22:11

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