Effectiveness and safety of robot-assisted versus fluoroscopy-assisted cortical bone trajectory screw instrumentation in spinal surgery: a systematic review and meta-analysis

Robot-assisted (RA) technology has been shown to be a safe aid in spine surgery, this meta-analysis aims to compare surgical parameters and clinical indexes between robot-assisted cortical bone trajectory (CBT) and fluoroscopy-assisted (FA) cortical bone trajectory in spinal surgery. We searched databases such as PubMed, Web of Science, the Cochrane Library, and the China National Knowledge Infrastructure. The study selection process was guided by the PICOS (Patient/Problem, Intervention, Comparison, Outcome, Study Design) strategy. The risk of bias in non-randomized comparative studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. We performed this meta-analysis using RevMan 5.3 software (Cochrane Collaboration, Copenhagen, Denmark), and the level of statistical significance was set at P < 0.05. Six articles involving 371 patients and 1535 screws were included in this meta-analysis. RA-CBT outperformed FA-CBT in terms of various parameters, such as accuracy of pedicle screw position (both Gertzbein-Robbins scale and Ding scale), avoidance of superior facet joint violation (FJV), and reduction of neurological injury. Our meta-analysis offered a thorough evaluation of the efficacy and safety of RA-CBT in spinal surgery. The findings revealed that RA-CBT produced statistically significant results in terms of pedicle screw position accuracy and superior facet joint violation prevention. In terms of surgical parameters and clinical indexes, future research and clinical practice should investigate the efficacy of RA-CBT further. The study was registered in the PROSPERO (CRD42023466280).