Robot-assisted technique versus freehand technique for spine surgery: an umbrella review

Pedicle screw internal fixation is a significant method for maintaining spinal stability. Despite the existence of numerous systematic reviews and meta-analyses that have evaluated the efficacy and safety of robotic-assisted compared to freehand technique, a comprehensive evaluation of the evidence’s strength and quality remains to be conducted. A comprehensive search of five major databases (i.e. PubMed, Embase, Cochrane, Web of Science, and Scopus) was conducted up to May 2024. The present umbrella review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of the included meta-analysis was evaluated by AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews). The quality of the evidence for each association was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. The present study incorporated a total of 22 meta-analyses, encompassing randomized clinical trials, cohort studies, and observational studies. A total of 14 associations with ‘perfect’ pedicle screw, ‘clinically acceptable’ pedicle screw, complications, facet joint violation, intraoperative radiation dose, intraoperative radiation time, and other related outcomes were evaluated in this umbrella review. Robot-assisted techniques in spine surgery have been found to be beneficial. The quality of the majority of the associations ranged from low to very low, indicating that flaws were certain in the current meta-analyses. This umbrella review indicated potential advantages of robotic-assisted technique for spine surgery, despite these findings with low certainty of the evidence, and cautious interpretation and application in clinical practice are needed.