Abstract
To the Editor,
The article by C. Li et al adds substantial contribution to the increasing body of knowledge that the introduction and routine clinical usage of advanced intraoperative CT-based image-guided techniques help to achieve higher precision and accuracy of placement of spinal instrumentation, thus, leading to improved clinical outcomes. 1
In a recent systematic review, Lu et al also noted that robotic-assisted surgery was significantly superior compared to traditional freehand techniques in terms of accuracy of pedicle screw placement for adult deformity that was reported to be 97.3% vs 92%, respectively, which was similar to the 96.3% vs 88%, respectively, reported by Li et al.1,2
Perhaps, one of the greatest advantages of the intraoperative CT-based navigation systems is the reduced radiation exposure for the surgical team which sometimes reaches “zero” because in most settings the team simply leaves the operating room during the intraoperative scanning. In a recent meta-analyses, Ciu et al and Wang et al independently found that robot-assisted pedicle screw insertion provided higher accuracy and shorter hospital stay in scoliosis surgery but, on the other hand, the conclusions regarding operative time, intraoperative blood loss and complication rates compared to conventional techniques were somehow contradictory.3,4
My personal belief after more than 1100 navigated pedicle screws placed by means of O-arm for a variety of pathologies is that such intraoperative CT-based systems can significantly increase the precision and accuracy of pedicle screw placement in the thoracic and lumbosacral spine. In the same time, they offer the greatest advantage for surgeons to perform simultaneous intraoperative correction of misplaced screws, thus avoiding the need for revision surgery later on. Variables such as operative time, blood loss, radiation exposure for patients can also be positively modified through experience, modifications and readjustments of imaging protocols and surgical technique.
