A comparison of key performance metrics of major robotic platforms in spine surgery: a network meta-analysis of 14,462 screws

PurposeThis meta-analysis compares prominent robotic platforms for spinal surgery, using conventional (freehand or fluoroscopy) and non-robotic navigation as common controls.MethodsLiterature searches were conducted using MEDLINE and EMBASE databases. Studies comparing screw placement of robot-assisted surgery with freehand/fluoroscopic or non-robotic navigation were included. Standard pairwise and network meta-analysis techniques with a random effects model (REM) were used with significance set at P < 0.05. Primary objective was to compare screw placement accuracy and breach incidence across robot platforms. Secondary objective was to compare neurologic complication (NC) rate and blood loss (BL) among platforms.ResultsA total of 27 studies totaling 3404 patients were included. The robotic group demonstrated significantly fewer breaches compared to the conventional group (OR 0.54, P = 0.0004). The TiRobot (TINAVI) and Renaissance (Mazor) demonstrated the best overall accuracy. The robotic group demonstrated significantly lower NC (OR 0.3, P = 0.02) and lower BL (MD: − 112.74 mL, P = 0.002) compared to the conventional approach (freehand or fluoroscopy). Potential conflicts of interest and source bias were found in 60% of TiRobot and 30% of SpineAssist studies. Robotic surgery had significantly lower major breach rates compared to non-robotic navigation (OR 0.39, P = 0.04). The Mazor X model was superior between all robotic platforms, with an OR of 0.15 (95% CrI 0.01 to 0.69, P < 0.00001, I2 = 0%) for major breaches compared to non-robotic navigation.ConclusionRobot-assisted navigation platforms show significant reduction in breach rates compared to conventional and non-robotic navigation approaches in adult spinal instrumentation surgery. MazorX (Mazor), TiRobot (TINAVI) and Renaissance (Mazor) emerge as leaders in robotic spine surgery, each contributing to the increase efficacy. To obtain a more reliable evidence base guiding clinical practice and decision-making on the safety, efficacy, and superiority of specific robot-assisted navigation platforms in spinal surgery, further unbiased RCTs with international collaborations are needed.