Revised in-depth meta-analysis on the efficacy of robot-assisted versus traditional free-hand pedicle screw insertion

Objective:Robot-assisted pedicle screw insertion has recently emerged as an alternative to the traditional free-hand technique.However,discrepancies in the accuracy of screw placement between the 2 methods have been highlighted by some comparative studies.This meta-analysis was conducted to synthesize evidence comparing these techniques.Methods:Searches were conducted in 5 electronic databases adhering to specific eligibility criteria for randomized and observational studies.The data were analyzed using RevMan software and the results are presented as odds ratios(ORs),mean differences,or standard mean differences(SMDs)with 95%confidence intervals(CIs).Our analysis included 12 studies(7 randomized trials and 5 observational studies,involving 883 patients and 4903 screws).Results:The results demonstrated a higher rate of Grade A Gertzbein and Robbins pedicle placement score(OR:1.77;95%CI:1.10e2.87),a lower rate of revision surgeries(OR:0.21;95%CI:0.09e0.52),and a shorter radiation exposure duration(SMD?1.38,95%CI:2.32 to0.44)in the robot-assisted group compared with the free-hand group.Nonetheless,the length of hospital stay,volume of intraoperative blood loss,postoperative visual analogue scale scores for back pain,and rate of wound infection were similar between the 2 groups.Significant heterogeneity was observed in some outcomes.Conclusion:Compared with the free-hand method,the robot-assisted technique provides greater accuracy and reduced radiation exposure.The efficacy of the robot-assisted technique is expected to improve further as experience with its use in surgery grows.

Cost-effectiveness of robotic-assisted spinal surgery:A single-center retrospective study

Objective:Robotic-assisted spine surgeries(RASS)have been shown to enhance precision,reduce operative time,prevent complications,facilitate minimally invasive spinal surgery,and decrease revision surgery rates,leading to improved patient outco mes This study aimed to compare the cost-effectiveness of RAs's and non-robotic-assisted surgery for degenerative spine disease at a single center.Me thods:This retrospective study,including 122 patients,was conducted at a single center from March 2015 to February 2022.Patients who underwent ro bot-assisted surgery were assigned to the robotgroup,and patients who underwent non-robotic-assisted surgery were assigned to the non-mmbot group.Various data,indluding demographic information,surgical details,outcomes,and cost-effectiveness,were colected for both groups.The cost-effectiveness was determined using the incremental cost-effectiveness ratio(ICER),and subgroup analysis was conducted for patients with 1 or 2 levels of spi-nal instrumentation.The analysis was performed using STATA SE version 15 and Tree.Age Pro 2020,with Monte Caro simulations for the cost-effectiveness acceptability curve.Results The owerallICER was$22,572,but it decreased to$16,980 when considering cases with only 1or 2 levels of instrumentation.RASS is deemed cost-effective when the willi ingness to pay is$3000-$4000 if less than 2 levels of the spine are instrumented.Conchsions:The cost-effectiveness of robot icassistance be comes apparent whenthere isa reduced need for open surgeries,leading to decreased d revision rates caused by complications such as misplaced screwsor infctions.Therefore,it is advisable to allocate healthcare budget resou Irces to spine robots,as RASS PIDves to be cost-effective,partic cularly when only two or Ewer spinal levels require instrumentation.