Optimizing Outcomes in Spinal Tumor Surgery: A Meta-analysis Comparing Robotic and Freehand Pedicle Screw Placement

Accurate pedicle screw placement is critical in spinal tumor and metastasis surgery to ensure stability while minimizing complications. Robot-assisted (RA) techniques have been introduced to improve precision, but their benefits over traditional freehand methods remain uncertain. This study systematically reviews and meta-analyzes the accuracy, safety, and efficiency of RA versus freehand pedicle screw placement in patients with spinal tumors and metastases.

A systematic search was conducted across five databases. Studies comparing RA and freehand pedicle screw placement in spinal tumor patients were included. Primary outcomes assessed screw accuracy using the Gertzbein-Robbins (GR) classification, while secondary outcomes included operative time, infection rates, and neurological complications. Data were pooled using odds ratios (OR) and mean differences (MD) with a random-effects model.

Three studies were included. RA significantly improved screw placement accuracy (GR A: 76.1% vs. 70.3%, OR 1.34, p = 0.023) and reduced minimally misplaced screws (GR B, OR 0.69, p = 0.010). The total percentage of clinically acceptable screws (GR A + B) was comparable between groups (90.9% vs. 90.7%, p = 0.953). RA surgery significantly reduced operative time (MD - 19.24 min, p < 0.01), while infection rates and neurological complications showed no significant differences.

RA pedicle screw placement showed a trend toward a higher rate of perfectly placed screws (GR A), though this was not confirmed by trial sequential analysis. Overall safety profiles were comparable. Further research is needed to evaluate the long-term outcomes and cost-effectiveness of spinal oncology surgery.