Article Figures & Data
Figures
- Figure 1
Flowchart diagram outlining the systematic review process used to identify the top 25 most-cited articles.
- Figure 2
Annual publication trends in articles on robotic lumbar spine surgery from 2000 to 2022.
- Figure 3
Number of published articles by journal on robotic lumbar spine surgery from 2000 to 2022.
Tables
- Table 1
Top 25 most-cited articles on robotic-assisted lumbar spine surgery ranked hierarchically by cumulative number of citations.
Author and Publication Year Journal Summary Description Times Cited (Total) Citations Per Year Robot System 1. Kantelhardt et al (2011)10 European Spine Journal Retrospective cohort analysis of 112 consecutive patients demonstrating shorter intraoperative fluoroscopy time and increased screw accuracy within open robotic-assisted vs conventional open pedicle screw placement. 221 20 SpineAssist 2. Devito et al (2010)11 Spine Retrospective observational case series of 3271 pedicle screw and guide-wire insertions with SpineAssist guidance across 14 hospitals from June 2005 to June 2009, wherein clinical acceptance and accuracy were assessed and compared with freehand techniques as reported by the literature. 215 18 SpineAssist 3. Hyun et al (2017)12 Spine Randomized clinical trial of 60 patients showing significantly reduced fluoroscopy exposure and length of stay in patients undergoing single- and two-level robotic-guided lumbar fusion relative to conventional fluoroscopic guidance. 148 30 Renaissance 4. Schatlo et al (2014)13 Journal of Neurosurgery: Spine Retrospective cohort analysis of 95 consecutive patients with degenerative lumbar pathologies showing comparable surgical time, length of stay, and screw placement accuracy in robotic-assisted vs fluoroscopy. 130 16 SpineAssist 5. Kim et al (2017)14 International Journal of Medical Robotics and Computer-Assisted Surgery Randomized controlled trial of 78 patients with lumbar spinal stenosis showing superior outcomes with respect to facet joint violation and convergence orientation with robotic-assisted PLIF vs conventional freehand techniques. 122 24 Renaissance 6. Lieberman et al (2006)15 Neurosurgery Observational cadaveric case study substantiating screw placement accuracy with SpineAssist when comparing actual screw and planned screw trajectories on postprocedure computed tomography. 120 8 SpineAssist 7. Pechlivanis et al (2009)16 Spine Prospective observational case series of 31 patients validating accuracy of pedicle screw placement in patients undergoing PLIF with percutaneous posterior pedicle screw insertion using passive guidance provided by a bone-mounted miniature robotic device (SpineAssist). 118 9 SpineAssist 8. Lonjon et al (2016)4 European Spine Journal Prospective 1:1 matched-cohort analysis of 20 consecutive patients reporting higher screw placement precision using robotic-assistance (ROSA) over freehand techniques. 111 19 ROSA 9. van Dijk et al (2015)17 Spine Retrospective case series of 112 consecutive patients undergoing PLIFs with SpineAssist demonstrating accurate screw placement, wherein intraoperative screw placement was consistent with preoperative plan. 92 13 SpineAssist 10. Lieberman et al (2012)18 Journal of Spinal Disorders and Techniques Prospective cohort analysis of 12 cadavers across 17 surgeons showing decreased radiation exposure, fluoroscopy time per screw, procedure time, screw placement deviation, and pedicle wall breaches while maintaining increased accuracy of percutaneous pedicle screw placement with the use of the SpineAssist system compared with freehand techniques. 91 9 SpineAssist 11. Keric et al (2017)19 Neurosurgical Focus Retrospective case series of 413 patients who underwent spinal screw implantation with Renaissance showing high reliability and accuracy in screw placement with lower peri- and early postoperative complications relative to other percutaneous screw placement techniques across the literature. 81 16 Renaissance 12. Barzilay et al (2006)20 International Journal of Medical Robotics and Computer-Assisted Surgery Prospective case series of 15 patients who underwent robot-assisted lumbar spine fusion with the SpineAssist system which identified technical and clinical variables contributing to difficult cases. 77 5 SpineAssist 13. Lefranc et al (2016)21 Expert Review of Medical Devices Technical review outlining surgical technique, indications for use, future directions, and advantages associated with use of the new ROSA robot in performing accurate pedicle screw placement and minimally invasive percutaneous surgical procedures. 73 12 ROSA 14. Khan et al (2019)5 Operative Neurosurgery Retrospective case series of 20 patients who underwent robotically assisted pedicle screw insertion performed by a single surgeon with preliminary results showing 98.7% accuracy in 75 pedicle screw placements, reinforcing feasibility of robotic guidance in lumbar spine surgery. 71 24 Mazor X 15. Kim et al (2015)22 Spine Prospective randomized controlled study that demonstrated similar quality of performance and accuracy as measured by a cumulative summation test in pedicle screw fixation in 20 patients who underwent robot-assisted MIS PLIF and 20 patients who underwent conventional open PLIF using freehand technique. 67 10 Renaissance 16. Schatlo et al (2015)23 Acta Neurochirurgica Retrospective chart review of 258 patients requiring thoracic and/or lumbar spine surgery with posterior instrumentation showed that robot-assisted screw placement is safe with a 3.8% screw malposition rate. 67 10 TiRobot 17. Gao et al (2018)24 European Spine Journal Systematic review and meta-analysis of 6 studies incorporating 158 patients (688 pedicle screws) in the robot-assisted group and 148 patients (672 pedicle screws) in the conventional freehand group demonstrated that both groups exhibited similar accuracy rate of pedicle screw implantation, but the robot-assisted technique was associated with longer operative time. 65 16 N/A (5 Mazor, 1 Tianji) 18. Le et al (2018)6 World Neurosurgery Retrospective matched-cohort study of 58 patients undergoing pedicle screw insertion through the cortical bone for lumbar fixation that demonstrated perfect trajectory for 87.2% of robotic-assisted screw insertion and 66.9% of conventional freehand screw instrumentation. 59 15 Renaissance 19. Urakov et al (2017)25 Neurosurgical Focus Retrospective review of prospectively collected data from 33 patients who underwent robot-assisted thoracolumbar pedicle instrumentation that showed no correlation regarding speed and accuracy of instrumentation between surgeon’s years of operative experience and commitment to spine surgery as their future speciality. 49 10 Renaissance 20. Li et al (2020)26 Spine Meta-analysis of 9 randomized controlled trials with 696 patients demonstrated that robot-assisted pedicle screw placement reduced radiation dose and decreased intraoperative radiation exposure time while showing greater accuracy compared with pedicle screw instrumentation by conventional freehand technique. 47 24 TiRobot 21. Schröder et al (2017)27 Neurosurgical Focus Retrospective cohort study of 72 patients who had undergone an MIS PLIF or MIS TLIF and completed a follow-up ≥12 months demonstrated that robot-guided screw trajectories are more accurate compared with trajectories established by freehand techniques which reduce rate of revision surgery for screw malposition and improve visual analog scale and Oswestry Disability Index scores. 46 9 Renaissance 22. Fan et al (2017)28 Medical Science Monitor Prospective cohort study of 890 pedicle screws placed in 190 patients for treatment of degenerative lumbar disease demonstrated that robot-assisted technique unsuccessfully showed significant differences for accuracy of pedicle screw insertion compared with freehand technique but greatly reduced blood loss, fluoroscopy time per screw, and postoperative stay. 45 9 SpineAssist 23. Kuo et al (2016)29 PLoS ONE Retrospective review of 64 patients who either underwent or did not undergo TLIF demonstrated that the Renaissance robotic system can accurately place pedicle screws, and secondary registration enhances accuracy by providing intraoperative evaluation of screw positioning. 45 8 Renaissance 24. Tian et al (2020)30 Neurospine Case series of 62 thoracolumbar pedicle screws implanted in 12 patients using 5G telerobotic remote telecommunication showed the potential of utilizing telemedical service in the future. 40 20 TiRobot 25. Wolf et al (2001)31 Spine Observational case series of morphometric data using computed tomography of the lumbar spine of 55 patients who provided additional information on vertebrae geometry and its relation to entry points for screw insertion for spinal procedures. 40 2 N/A Abbreviations: MIS, minimally invasive surgery; PLIF, posterior lumbar interbody fusion; TLIF, transforaminal lumbar interbody fusion.
- Table 2
Newcastle-Ottawa assessment scale of cohort studies within the top 25 most-cited articles ordered by citation ranking.
Study Representative of Cohorts Selection of Nonexposed Cohort Ascertainment of Exposure Outcome of Interest Absent at Start of Study Cohort Comparability Outcome Assessment Sufficient Follow-up Adequacy of Follow-up Total Score 1. Kantelhardt et al (2011)10 * * * * * * * * 8 3. Hyun et al (2017)12 * * * * ** * * * 9 4. Schatlo et al (2014)13 * * * * ** * * * 9 5. Kim et al (2017)14 * * * * ** * * * 9 8. Lonjon et al (2016)4 * * * * * * * * * 9 10. Lieberman et al (2012)18 - - * - - * * * 4 15. Kim et al (2015)22 * * * * - * * * 7 18. Le et al (2018)6 - - * * * * * * 6 19. Urakov et al (2017)25 - - - - - - - - 0 21. Schröder et al (2017)27 - - - - - - - - 0 22. Fan et al (2017)28 * * * * - * * * 7 - Table 3
Joanna Briggs Institute (JBI) critical appraisal tool assessments of case series within the top 25 most-cited articles ordered by citation ranking.
JBI Assessment Categories 2. Devito et al (2010) 6. Lieberman et al (2006) 7. Pechlivanis et al (2009) 9. van Dijk et al (2015) 11. Keric et al (2017) 12. Barzilay et al (2006) 14. Khan et al (2019) 16. Schatlo et al (2015) 23. Kuo et al (2016) 24. Tian et al (2020) 25. Wolf et al (2001) Clear inclusion criteria No No Yes Yes Yes No Yes Yes Yes No No Reliable data collection No Yes No Yes Yes No Yes Yes Yes No No Valid methodology for assessing outcomes Yes Yes Yes Yes Yes No Yes Yes Yes No No Consecutive series Yes No Yes Yes Yes Yes Yes Yes Yes No No Inclusion of all possible participants/cases No No Yes No Yes Yes Yes Yes Yes No Yes Relevant demographics reported Yes No Yes Yes Yes Yes No No Yes Yes Yes Baseline clinical characteristics reported No No No No Yes Yes No No Yes No No Clear description of outcomes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Study site/setting described Yes No No No Yes Yes No No Yes Yes No Appropriate statistical analysis Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Total Score (/10) 6 4 7 7 10 6 8 7 10 4 3
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