Comparison of Robot-Assisted Versus Fluoroscopy-Guided Transforaminal Lumbar Interbody Fusion(TLIF) for Lumbar Degenerative Diseases: A Systematic Review Meta-Analysis of Trails and Observational Studies
Notice bibliographique
Résumé
Abstract Background As an emerging robot-assisted (RA) technology, whether its application in transforaminal lumbar interbody fusion (TLIF) is more worthwhile has not been supported by relevant evidence thus far. Moreover, utilizing RA procedures for TLIF places a greater financial burden on patients when compared to traditional fluoroscopy-guided (FG) TILF. As a result, the appropriateness of implementing RA in TLIF surgery remains uncertain. Objective We aimed to investigate whether the RA TLIF is superior to FG TLIF in treating lumbar degenerative disease. Methods We systematically reviewed PubMed, Embase, Web of Science, CNKI, WanFang, VIP and the Cochrane Library as well as the references of published review articles for relevant studies of comparison of RA versus FG TLIF for lumbar degenerative diseases through July 2023. Cohort studies (CSs) and randomized controlled trials (RCTs) were included. The evaluation criteria consisted of accuracy of percutaneous pedicle screw placement, proximal facet joint violation (FJV), radiation exposure, duration of surgery, estimated blood loss (EBL) and revision case. Quality was assessed using the Cochrane Collaboration tool for RCTs and the Newcastle-Ottawa Scale (NOS) for CSs. Results Our search identified 539 articles, of which 21 met the inclusion criteria for quantitative analysis. Meta-analysis revealed that RA had 1.03-folds higher “clinically acceptable” accuracy than FG (RR: 1.0382, 95% CI: 1.0273–1.0493). And RA had 1.12-folds higher “perfect” accuracy than FG group (RR: 1.1167, 95% CI: 1.0726–1.1626). For proximal FIV, the results suggest that the patients who underwent RA pedicle screw placement had 74% fewer proximal-facet joint violation than the FG group (RR: 0.2606, 95%CI: 0.2063–0.3293). Seventeen CSs and two RCTs reported the duration of time. The results of CSs suggest that there is no significant difference between RA and FG group (SMD: 0.1111, 95%CI: -0.391-0.6131), but the results of RCTs suggest that the patients who underwent RA-TLIF need more surgery time than FG (SMD: 3.7213, 95%CI: 3.0756–4.3669). Sixteen CSs and two RCTs reported the EBL. The results suggest that the patients who underwent RA pedicle screw placement had fewer EBL than FG group (CSs: SMD: -1.9151, 95%CI: -3.1265–0.7036, RCTs: SMD: -5.9010, 95%CI: -8.7238–3.0782). For radiation exposure, the results of CSs suggest that there is no significant difference in radiation time between RA and FG group (SMD: -0.5256, 95%CI: -1.4357-0.3845), but the patients who underwent RA pedicle screw placement had fewer radiation dose than FG group (SMD: -2.2682, 95%CI: -3.1953–1.3411). And four CSs and one RCT reported the number of revision case. The results of CSs suggest that there is no significant difference in the number of revision case between RA and FG group (RR: 0.4087,95% CI 0.1592–1.0495). Our findings are limited by the heterogeneity of the included studies. Conclusion In TLIF, RA technology demonstrates more accurate placement of pedicle screws compared to FG, offering advantages in protecting adjacent facet joints and reducing intraoperative radiation dosage and blood loss. However, due to longer preoperative preparation time, the surgical duration and radiation time of RA is comparable to FG techniques. Currently, FG screw placement continues to be the predominant technique, and clinical surgeons have greater proficiency in its application. Consequently, the integration of RA into TLIF surgery may not be an optimal choice.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,021 | 0,045 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,024 | 0,039 |
| Bibliométrie | 0,007 | 0,009 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».