Comparison of accuracy of pedicle screw placement for adolescent idiopathic scoliosis using freehand fluoroscopic, navigation, and robotic-assisted techniques - a systematic review and bayesian network meta-analysis

Adolescent idiopathic scoliosis (AIS) is a prevalent spinal deformity, often requiring surgical intervention. Posterior pedicle spine instrumentation, a common procedure for correcting AIS, can be performed using freehand fluoroscopic (FHF), navigation-assisted (NVA), or robotic-assisted (RBA) techniques for pedicle screw insertion. This study aimed to evaluate the accuracy and clinical outcomes of these techniques through a Bayesian network meta-analysis (BNMA) of 764 patients and 8,144 screws from twelve studies. Our findings suggest that RBA offers superior accuracy in pedicle screw placement compared to both FHF and NVA. However, RBA is associated with longer operative times. NVA, in contrast, provides a balanced approach by offering good accuracy with relatively shorter surgery times. No significant differences were observed in blood loss, Cobb angle correction, or hospital stay between the techniques. Additionally, no statistically significant differences were found between RBA and NVA in terms of operative duration or blood loss. These results have important clinical implications, indicating that RBA may be the preferred option for achieving high precision, particularly in complex cases, while NVA remains a viable alternative for quicker procedures. Further research is needed to assess the long-term outcomes, radiation exposure, and cost-effectiveness of these techniques in clinical practice.