Comparison of robotic or computer-assisted navigation versus fluoroscopic freehand techniques in the accuracy of posterior cervical screw placement during cervical spine surgery: a meta-analysis

医学 荟萃分析 置信区间 优势比 随机对照试验 颈椎 可视模拟标度 颈椎 外科 内科学
作者
Lu-Ping Zhou,Renjie Zhang,Yi Shang,Chen-Hao Zhao,Kang Liang,Chong-Yu Jia,Jiaqi Wang,Huaqing Zhang,Cailiang Shen
出处
期刊:Journal of neurosurgery [Journal of Neurosurgery Publishing Group]
卷期号:: 1-11
标识
DOI:10.3171/2024.5.spine24207
摘要

OBJECTIVE Robot guidance (RG) and computer-assisted navigation (CAN) have been increasingly utilized for posterior cervical screw placement in cervical spine surgery, and cervical screw malposition may contribute to catastrophic complications. However, the superiority of the navigation using RG or CAN compared with conventional freehand (FH) techniques remains controversial, and no meta-analysis comparing the two methods in cervical spine surgery has been performed. METHODS The PubMed, Embase, Web of Science, Cochrane, China National Knowledge Infrastructure, and Wanfang databases were searched for eligible literature. Studies reporting the primary outcomes of the accuracy of cervical screw placement using RG or CAN compared with FH techniques were included. Bias was evaluated using the Cochrane risk of bias criteria and the Newcastle-Ottawa Scale. The outcomes were evaluated in terms of odds ratio or standardized mean difference and corresponding 95% confidence interval. RESULTS One randomized controlled trial and 18 comparative cohort studies published between 2012 and 2023 consisting of 946 patients and 4163 cervical screws were included in this meta-analysis. The RG and CAN techniques were associated with a substantially higher rate of optimal and clinically acceptable cervical screw accuracy than FH techniques. Furthermore, compared with the FH group, the navigation group showed fewer postoperative adverse events, less blood loss, shorter hospital lengths of stay, and lower postoperative Neck Disability Index scores. However, the navigation and FH groups had equivalent intraoperative times and postoperative visual analog scale and Japanese Orthopaedic Association scores at the final follow-up. CONCLUSIONS Both RG and CAN are superior to FH techniques in terms of the accuracy of cervical screw placement. Navigation techniques, including RG and CAN methods, are accurate, safe, and feasible in cervical spine surgery.

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