title: Comparison of the accuracy between robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a systematic review and meta-analysis to investigate the different of accuracy between robot-assisted and conventional freehand pedicle screw placement.
  
  
  METHODS
  The electronic databases of PubMed, Ovid MEDLINE, EMBASE, and Web of Science were searched for the literatures published up to January, 2016. Statistical analysis was performed using the Review Manager 5.3. The dichotomous data for the pedicle violation rate were summarized using relative risk (RR) and 95 % confidence intervals (CIs). The level of significance was set at [Formula: see text].
  
  
  RESULTS
  A total of 257 patients and 1105 screws were included in the five studies for this meta-analysis. The results revealed that there was no difference in the accuracy between robot-assisted and conventional freehand pedicle screw placement at the 0 mm grading criteria (RR 1.08, 95 % CI 0.86, 1.35, [Formula: see text], [Formula: see text]) and at 2 mm grading criteria (RR 1.02, 95 % CI 0.68, 1.51, [Formula: see text], [Formula: see text]). Among percutaneous robot-assisted technique, open robot-assisted technique and conventional freehand technique, there was also no significant difference at 0mm grading criteria (RO(P) vs FH : RR 1.10, 95 % CI 0.87, 1.40, [Formula: see text], [Formula: see text]; RO(O) versus FH : RR 0.87, 95 % CI 0.55, 1.38, [Formula: see text], [Formula: see text]; RO(P) vs RO(O): RR 1.20, 95 % CI 0.65, 2.24, [Formula: see text]) and at 2 mm grading criteria(RO(P) vs FH : RR 1.07, 95 % CI 0.43, 2.67, [Formula: see text], [Formula: see text]; RO(O) vs FH : RR 0.71, 95 % CI 0.36, 1.39, [Formula: see text], [Formula: see text]; RO(P) vs RO(O) : RR 0.84, 95 % CI 0.36, 1.94, [Formula: see text]).
  
  
  CONCLUSIONS
  Further high-quality studies are required to unequivocally recommend one surgical technique over the other. With the more application of robot-assisted navigation system, accuracy and clinical benefit of the technique will be gradually improved.
authors.affiliation: Department(s) and institution(s), Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department(s) and institution(s), Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
authors.forename: Weikai
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department(s) and institution(s), Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
authors.forename: Zongyi
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department(s) and institution(s), Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department(s) and institution(s), Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Meng
authors.affiliation: Department(s) and institution(s), Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. szyhlspine@163.com.|Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, China. szyhlspine@163.com.
authors.forename: Huilin
authors.initials: H
authors.lastname: Yang
mesh_terms: D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D065289:Pedicle Screws; D016032:Randomized Controlled Trials as Topic; D012371:Robotics; D012447:Sacrum / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery
keywords: Accuracy; Navigation; Pedicle screw; Robot assisted; Spinal surgery