Robot Assisted versus Extended Reality Assisted Vertebral Augmentation: Meta-analysis

Introduction: Even though previous literature has indicated the benefits of using robot assistance with spinal injections, the benefits of robot-assisted (RA) vertebral augmentation are conflicting. With the emergence of extended-reality-assisted (ERA) vertebral augmentation, which incorporates augmented or mixed reality with the injection, this study aims to compare the effectiveness of using ERA versus RA vertebral augmentation.

Methods: A literature search through Pubmed, SCOPUS, EMBASE, and Cochrane was conducted using a combination of the following keywords: “Robot,” “Robot-assisted,” “Mixed-Reality,” and “Augmented-Reality” with “Vertebral Augmentation,” “Kyphoplasty,” “Vertebroplasty,” and “Spinal Augmentation.” Studies that compared either RA or ERA vertebral augmentation, specifically vertebroplasty and kyphoplasty, with free hand were included. Data regarding operative time, fluoroscopy times, and 3-month postoperative ODI and VAS scores were collected. Mann-Whitney-U test was used to compare the standardized difference using Hedge’s g corrected for small sample size bias between the ERA and RA groups and free hand groups.

Results: From the search, eleven papers on robot assistance and two on ER assistance were included in this study. When comparing the standardized differences between the two types of vertebral augmentation and the free hand, ERA vertebral augmentation provided significantly lower operative and fluoroscopy times than RA (Asymp. p < 0.05). VAS and ODI scores were not statistically significant.

Conclusion : ERA provides greater benefits for vertebral augmentation compared to RA. For this reason, further prospective clinical research needs to be done on the benefits of using ERA vertebral augmentation and its benefits compared to free-hand vertebral augmentation in the clinic.