Efficacy and safety of robot-assisted versus fluoroscopy-assisted PKP or PVP for osteoporotic vertebral compression fractures: a systematic review and meta-analysis

Percutaneous vertebral augmentation (PVA), which includes percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Robot-assisted (RA) and fluoroscopy-assisted (FA) are important methods for treating osteoporotic vertebral compression fractures (OVCFs), though it is still unclear which is superior. This analysis aimed to compare the efficacy and safety of RA and FA. PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure were systematically searched, the outcomes included surgical parameters (leakage rate, operation time, number of fluoroscopic, injection volume, inclination angle), and clinical indexes (hospital stays, Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, the midline height of vertebral). Thirteen articles involving 1094 patients were included. RA group produced better results than the FA group in the leakage rate (OR = 0.27; 95% CI 0.17–0.42; P < 0.00001), number of fluoroscopic (WMD = – 13.88; 95% CI – 18.47 to – 9.30; P < 0.00001), inclination angle (WMD = 5.02; 95% CI 4.42–5.61; P < 0.00001), hospital stays (WMD = – 0.32; 95% CI – 0.58 to – 0.05; P = 0.02), VAS within 3 days (WMD = – 0.19; 95% CI – 0.26 to – 0.12; P < 0.00001), Cobb angle within 3 days (WMD = – 1.35; 95% CI – 2.56 to – 0.14; P = 0.003) and Cobb angle after 1 month (WMD = – 1.02; 95% CI – 1.84 to – 0.20; P = 0.01). But no significant differences in operation time, injection volume, ODI, the midline height of vertebral, and VAS score after 1 month. Our analysis found that the RA group had lower cement leakage rates, number of fluoroscopic and hospital stays, a larger inclination angle, better short-term pain improvement, and Cobb angle improvement. It is worth acknowledging that robotic-assisted surgery holds promise for the development of spine surgery. The study was registered in the PROSPERO (CRD42023393497).