Accuracy and safety of robot-assisted pedicle screw placement in the management of cervical spine disorders.

To systematically evaluate and compare the accuracy and safety of robot-assisted versus conventional freehand pedicle screw placement in the surgical management of cervical spine disorders. A comprehensive literature search was conducted to identify published comparative studies. Eligible studies were selected according to predefined criteria. Relevant data were extracted, and methodological quality was assessed. Pooled effect estimates were calculated using meta-analytic techniques to compare perioperative parameters, screw placement accuracy, and clinical outcomes between the two surgical approaches. Compared with conventional techniques, robot-assisted pedicle screw placement was associated with a longer overall operative time (MD = 37.52 min, 95% CI 17.69–57.34) but a shorter insertion time per screw (MD = − 1.50 min, 95% CI − 2.00 to − 1.00). In addition, robotic assistance was associated with reduced intraoperative blood loss (MD = − 49.82 mL, 95% CI − 91.71 to − 7.93) and shorter postoperative hospital stay (MD = − 1.31 days, 95% CI − 2.26 to − 0.37). Regarding screw placement accuracy, the robot-assisted group demonstrated a significantly higher proportion of GRAD grade A + B screws (OR = 3.89, 95% CI 1.77–8.53) and Grade 0 screws (OR = 1.51, 95% CI 1.08–2.12). A small but statistically significant reduction in Neck Disability Index scores at 3 months was also observed (MD = − 0.69, 95% CI − 1.18 to − 0.21). Current evidence suggests that robot-assisted pedicle screw placement offers advantages in terms of screw placement accuracy, postoperative functional recovery, and reduced length of hospital stay in patients with cervical spine disorders. The choice of surgical technique should be individualized based on patient characteristics, availability of robotic systems, and surgeon expertise.