Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review

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Title: Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review
Authors: Marcus, HJ
Cundy, TP
Nandi, D
Yang, G-Z
Darzi, A
Item Type: Journal Article
Abstract: Purpose At present, most spinal surgeons undertake pedicle screw implantation using either anatomical landmarks or C-arm fluoroscopy. Reported rates of screw malposition using these techniques vary considerably, though the evidence generally favors the use of image-guidance systems. A miniature spine-mounted robot has recently been developed to further improve the accuracy of pedicle screw placement. In this systematic review, we critically appraise the perceived benefits of robot-assisted pedicle screw placement compared to conventional fluoroscopy-guided technique. Methods The Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases were searched between January 2006 and January 2013 to identify relevant publications that (1) featured placement of pedicle screws, (2) compared robot-assisted and fluoroscopy-guided surgery, (3) assessed outcome in terms of pedicle screw position, and (4) present sufficient data in each arm to enable meaningful comparison (>10 pedicle screws in each study group). Results A total of 246 articles were retrieved, of which 5 articles met inclusion criteria, collectively reporting placement of 1,308 pedicle screws (729 robot-assisted, 579 fluoroscopy-guided). The findings of these studies are mixed, with limited higher level of evidence data favoring fluoroscopy-guided procedures, and remaining comparative studies supporting robot-assisted pedicle screw placement. Conclusions There is insufficient evidence to unequivocally recommend one surgical technique over the other. Given the high cost of robotic systems, and the high risk of spinal surgery, further high quality studies are required to address unresolved clinical equipoise in this field.
Issue Date: 1-Feb-2014
Date of Acceptance: 18-Jun-2013
ISSN: 0940-6719
Publisher: Springer Verlag
Start Page: 291
End Page: 297
Journal / Book Title: European Spine Journal
Volume: 23
Issue: 2
Copyright Statement: © 2014 Springer-Verlag. The final publication is available at Springer via
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: NF-SI-0510-10186
Keywords: Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Neurosciences & Neurology
Robot assisted
Fluoroscopy guided
Pedicle screw
Bone screw
Spinal surgery
Systematic review
Pedicle Screws
Robotic Surgical Procedures
Spinal Fusion
0903 Biomedical Engineering
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2013-06-26
Appears in Collections:Faculty of Engineering
Division of Surgery
Department of Medicine
Faculty of Medicine

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