Robotics in Cervical Spine Surgery: Feasibility and Safety of Posterior Screw Placement

Neurospine, 2023 · DOI: https://doi.org/10.14245/ns.2244952.476 · Published: January 1, 2023

Assistive Technology Surgery Research Methodology & Design

Simple Explanation

Cervical screw instrumentation is used for treating cervical spinal diseases, providing biomechanical stabilization and protecting the spinal cord. However, the complex anatomy of the cervical region increases the risk of complications from misplaced screws. Robot-assisted (RA) techniques have shown promise in thoracolumbar spine surgery. This meta-analysis investigates the feasibility and safety of RA screw placement in cervical spine surgery. This study aims to demonstrate the safety and accuracy of cervical screw placement using RA methods, which might provide references for surgeons in the selection of insertion methods and revolutionization of spinal surgeries, following improvement of RA techniques.

Study Duration

August 2015–August 2018 (longest duration)

Participants

160 patients and 719 cervical screws

Evidence Level

Meta-analysis of one RCT, three comparative cohort studies, and three case series

Key Findings

1
The meta-analysis indicated that robot-assisted techniques achieved an 88.0% rate of optimal cervical screw placement accuracy.
2
The rate of clinically acceptable screw placement with RA techniques was 98.4%.
3
Subgroup analyses showed high rates of optimal screw positions on C1 (96.2%), C2 (89.7%), and subaxial cervical segments (82.6%) when using RA techniques.

Research Summary

This meta-analysis examined the safety and accuracy of robot-assisted (RA) techniques for cervical screw placement in spine surgery. It included one RCT, three comparative cohort studies, and three case series, encompassing 160 patients and 719 cervical screws. The study found that RA techniques were associated with high rates of both optimal (88.0%) and clinically acceptable (98.4%) screw positions. Subgroup analyses indicated similar accuracy for pedicle screw placement and across different cervical segments (C1, C2, subaxial). The authors conclude that RA cervical screw placement is accurate, safe, and feasible, holding promising clinical potential for cervical spine surgery.

Practical Implications

Improved Accuracy and Safety

RA techniques can improve the accuracy and safety of cervical screw placement, potentially reducing neurological damage and vertebral artery injury.

Reduced Reliance on Surgical Experience

RA methods can mitigate the challenges posed by complex cervical anatomy and reduce the dependence on extensive surgical experience.

Future of Spinal Surgery

The findings support the continued development and adoption of RA techniques in spinal surgery, including minimally invasive procedures and remote surgery applications.

Study Limitations

1
Single-arm meta-analysis lacks a direct comparison with conventional freehand methods.
2
The inclusion of only seven studies with a limited sample size restricts the generalizability of the findings.
3
Potential bias due to a majority of the studies being conducted in China.

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