Robot-assisted and augmented reality-assisted thoracolumbar instrumentation is advantageous for both patients and surgeons but, as the technology progresses and indications expand, it remains essential to continue investigations of both in order to validate meaningful benefit over conventional instrumentation techniques in spine surgery. These are the key findings from a recent systematic review and meta-analysis, published in the Journal of Neurosurgery: Spine by Matthew Tovar (George Washington University, Washington DC, USA) et al.
The use of technology-enhanced methods in spine surgery “has increased immensely over the past decade” say the study authors, whose research sought to address patient-centred outcomes, including the risk of inaccurate screw placement and perioperative outcomes in spinal surgeries using robotic instrumentation and/or augmented reality surgical navigation (ARSN).
A systematic review of the literature in the PubMed, EMBASE, Web of Science, and Cochrane Library databases spanning the last decade (January 2011–November 2021) was performed to present all clinical studies comparing robot-assisted instrumentation and ARSN with conventional instrumentation techniques in lumbar spine surgery.
The authors compared these two technologies as they relate to screw accuracy, estimated blood loss (EBL), intraoperative time, length of stay (LOS), perioperative complications, radiation dose and time, and the rate of reoperation.
In total, 64 studies were analysed which included 11,113 patients who received 20,547 screws. The researchers found that robot-assisted instrumentation was associated with less risk of inaccurate screw placement (p<0.0001) regardless of control arm approach (freehand, fluoroscopy guided, or navigation guided), fewer reoperations (p<0.0001), fewer perioperative complications (p<0.0001), lower EBL (p=0.0005), decreased LOS (p<0.0001), and increased intraoperative time (p=0.0003).
Meanwhile, ARSN was associated with decreased radiation exposure compared with robotic instrumentation (p=0.0091) and fluoroscopy-guided (p<0.0001) techniques.
Speaking to Spinal News International, Tovar said: “Technology-enhanced instrumentation for spinal surgery has the capacity to revolutionise posterior lumbar instrumentation for degenerative disease. These robotic devices; however, continue to be financially lucrative, costing upwards of millions of US dollars.
“In our study, we showcase improved accuracy and better patient outcomes in patients with robot-assisted and augmented reality surgical navigation. It is the hope that hospital enterprises take note of these outcomes and work to make access to technology-enhanced instrumentation a more equitable option for all patient populations.”