Robot-Assisted versus Conventional Vertebral Augmentation Procedures-Bayesian Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Studies.

Abstract

This study employed a Bayesian methodology and compared robot-assisted (RA) vertebral augmentation (VA) to conventional VA from randomized studies. RA surgery is rapidly growing in numbers, and more recently, it has been applied to minimally invasive VA procedures. However, no meta-analysis has evaluated the clinical effectiveness of RA-VA compared to conventional VA, solely focusing on randomized controlled trials (RCTs). Authors systematically searched PubMed, Embase, and Web of Science for eligible RCTs. Outcomes of interest included cement leak, cement volume, procedure time, pain, Cobb's angle after procedure, and fluoroscopy use. The authors employed a noninformative random effects Bayesian meta-analysis and trial sequential analysis. This study included four articles, all from China. RA-VA showed a lower incidence of cement leak events (risk ratio 0.24, 95% credible interval [CrI] 0.08-0.73), reduced fluoroscopy use (mean difference -5.66, 95% CrI -8.93 to -2.23), and shorter procedure time (mean difference -17.65, 95% CrI -25.71 to -9.19). However, some heterogeneity and quality concerns were observed in the included studies. RCTs provide significant evidence that the RA-VA procedures are safe and that computer-aided navigation enhances the precision of VA procedures. This results in fewer cement leak events, shorter procedures, and reduced fluoroscopy use. However, the number of randomized studies remains relatively limited.