Evidence map›Paper›PMID 40025377›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025

A surgeon-controlled mode of robotic assistance with posterolateral approach helps achieve highly medialized cervical pedicle screw placement to avoid vertebral artery injury.

Yoichi Tani, Nobuhiro Naka, Naoto Ono, Koki Kawashima, Masaaki Paku, Masayuki Ishihara, Takashi Adachi, Shinichirou Taniguchi, Muneharu Ando, Takanori Saito

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Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

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0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Yoichi TaniDepartment of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan. taniyoic@gmail.com.ORCID 0000-0002-3424-4463
Nobuhiro NakaDepartment of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
Naoto OnoDepartment of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
Koki KawashimaDepartment of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
Masaaki PakuDepartment of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
Masayuki IshiharaDepartment of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
Takashi AdachiDepartment of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
Shinichirou TaniguchiDepartment of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
Muneharu AndoDepartment of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
Takanori SaitoDepartment of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe small pedicle widths, the thin lateral cortical shell next to the vertebral artery (VA), and the strongly tilted pedicle axis anteromedially narrow the safety margin for cervical pedicle screw (CPS) placement against vertebral artery (VA) injury. We have studied whether the minimally invasive surgery (MIS) of a posterolateral approach with a table-mounted, surgeon-controlled mode of robotic assistance (group R) improves the VA safety compared to C-arm fluoroscopy-guided conventional open technique (group F).

methodsGroup R consisted of 165 screws in 37 patients and group F, 199 screws in 52 patients. The two groups covered a broad range of vertebral levels from C2 to C7 with comparable distribution (p = 0.0512) for treating a similar variety of diseases (p = 0.6958).

resultsGroup R, compared with group F, showed a greater lateral-to-medial CPS inclination (p ≤ 0.0004) that even exceeded the obliquity of corresponding pedicle axis, leading to a higher rate of acceptable CPS placement (93.4% vs. 85.4%; p = 0.0164) with a lower rate of lateral breach (1.2% vs. 10.1%; p = 0.0004).

conclusionFor CPS placement, robot-assisted MIS obviously eliminates morbidity-prone soft-tissue dissection, radiation exposure to the surgical team, and human manual errors. The current study revealed its additional benefit of better safety against VA injury by allowing us to place CPS with a steep lateral-to-medial angulation owing to (1) a lack of counter pressure from the paravertebral muscles and (2) minimizing a navigation pitfall of untracked pressure-induced vertebral rotation.

Indexed as

Cervical VertebraeMinimally Invasive Surgical ProceduresPedicle ScrewsRobotic Surgical ProceduresSpinal FusionVertebral ArteryAdultAgedFemaleHumansMaleMiddle AgedCBCT-based navigationCervical pedicle screwMinimally invasive surgeryPosterolateral approachSurgeon-controlled robotic surgery

Identifiers

PMID40025377

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.