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Efficacy and safety of robot-assisted versus fluoroscopy-assisted PKP or PVP for osteoporotic vertebral compression fractures: a systematic review and meta-analysis

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Abstract

Percutaneous vertebral augmentation (PVA), which includes percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Robot-assisted (RA) and fluoroscopy-assisted (FA) are important methods for treating osteoporotic vertebral compression fractures (OVCFs), though it is still unclear which is superior. This analysis aimed to compare the efficacy and safety of RA and FA. PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure were systematically searched, the outcomes included surgical parameters (leakage rate, operation time, number of fluoroscopic, injection volume, inclination angle), and clinical indexes (hospital stays, Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, the midline height of vertebral). Thirteen articles involving 1094 patients were included. RA group produced better results than the FA group in the leakage rate (OR = 0.27; 95% CI 0.17–0.42; P < 0.00001), number of fluoroscopic (WMD = – 13.88; 95% CI – 18.47 to – 9.30; P < 0.00001), inclination angle (WMD = 5.02; 95% CI 4.42–5.61; P < 0.00001), hospital stays (WMD = – 0.32; 95% CI – 0.58 to – 0.05; P = 0.02), VAS within 3 days (WMD = – 0.19; 95% CI – 0.26 to – 0.12; P < 0.00001), Cobb angle within 3 days (WMD = – 1.35; 95% CI – 2.56 to – 0.14; P = 0.003) and Cobb angle after 1 month (WMD = – 1.02; 95% CI – 1.84 to – 0.20; P = 0.01). But no significant differences in operation time, injection volume, ODI, the midline height of vertebral, and VAS score after 1 month. Our analysis found that the RA group had lower cement leakage rates, number of fluoroscopic and hospital stays, a larger inclination angle, better short-term pain improvement, and Cobb angle improvement. It is worth acknowledging that robotic-assisted surgery holds promise for the development of spine surgery. The study was registered in the PROSPERO (CRD42023393497).

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Data availability

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

OVCFs:

Osteoporotic vertebral compression fractures

PVA:

Percutaneous vertebral augmentation

PKP:

Percutaneous kyphoplasty

PVP:

Percutaneous vertebroplasty

RA:

Robot-assisted

FA:

Fluoroscopy-assisted

BMI:

Body mass index

BMD:

Bone mineral density

VAS:

Visual analog scale

ODI:

Oswestry disability index

RCT:

Randomized controlled trial

WMD:

Weighted mean difference

SMD:

Standardized mean difference

CI:

Confidence interval

OR:

Odds ratio

CT:

Computed tomography

M–H:

Mantel–Haenszel

IV:

Inverse variance

df:

Degrees of freedom

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Acknowledgements

The authors acknowledged the Department of Statistics, Public Health College of Jilin University for their suggestions concerning the statistical analysis in this manuscript.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.                  

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Authors and Affiliations

  1. Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin, China

    Xu Wang, Yu-hang Zhu & Qing-san Zhu

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Contributions

Q-sZ designed the study protocol. XW and Y-hZ managed the literature search and data acquisition. XW and Y-hZ performed the statistical analysis and drafted the manuscript. Q-sZ provided critical revision to the manuscript. Q-sZ resolved ambiguities during the study and gave final approval of the manuscript.

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Correspondence to Yu-hang Zhu or Qing-san Zhu.

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Wang, X., Zhu, Yh. & Zhu, Qs. Efficacy and safety of robot-assisted versus fluoroscopy-assisted PKP or PVP for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. J Robotic Surg 17, 2597–2610 (2023). https://doi.org/10.1007/s11701-023-01700-0

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