Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery?
Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery?
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DOI：
10.3171/2021.10.focus21526
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发表时间：
2022-01-01
影响因子：
4.1
通讯作者：
Qureshi, Sheeraz A
中科院分区：
文献类型：
--
作者：
Shafi, Karim A;Pompeu, Yuri A;Qureshi, Sheeraz A
目的：随着机器人和手术导航技术的出现，经皮椎弓根螺钉置入的准确性有所提高。然而，机器人术中螺钉尺寸和轨迹模板的影响仍不清楚。本研究的目的是比较椎弓根螺钉的大小和准确性的位置，使用机器人导航（RN）与皮肤为基础的术中导航（ION）单独在微创腰椎fusion procedures.METHODS：一项回顾性队列研究进行了一个单一的机构注册的脊柱手术进行了4年的时间。纳入了接受单节段或双节段初次或翻修微创手术（MIS）-经椎间孔腰椎椎间融合术（TLIF）并通过机器人辅助或单独手术导航置入椎弓根螺钉的患者。收集人口统计学、手术和影像学数据。评估椎弓根螺钉类型、数量、长度、直径以及终板破坏或小关节破坏的存在。使用Student t检验和卡方检验进行统计分析，以评估两组之间椎弓根螺钉尺寸和放置准确性的差异。结果：总共纳入了222例患者，其中92例接受了RN，130例接受了ION MIS-TLIF。分别使用RN和ION共置入403枚和534枚椎弓根螺钉。RN和ION组的平均螺钉直径分别为7.25 ± 0.81 mm和6.72 ± 0.49 mm（p < 0.001）。RN组的平均螺钉长度为48.4 ± 4.48 mm，ION组为45.6 ± 3.46 mm（p < 0.001）。RN和ION组的“理想”椎弓根螺钉率相当，分别为88.5%和88.4%（p = 0.969）。整体螺钉放置也相似。RN队列中63.7%的螺钉被评定为良好，31.4%的螺钉被评定为可接受，而66.1%的ION螺钉放置良好，28.7%的螺钉放置可接受（分别为p = 0.661和p = 0.595）。与ION组（1.2%，n = 17，p = 0.05）相比，RN组（0%，n = 0）的高级别破坏显著减少。结论：本研究的结果表明，与单独手术导航相比，机器人辅助允许放置具有更大螺钉直径和长度的螺钉，尽管精度相似。这些发现表明，机器人平台可以安全放置“最佳螺钉”，最大限度地提高结构稳定性，从而获得成功融合的能力。
OBJECTIVE: The accuracy of percutaneous pedicle screw placement has increased with the advent of robotic and surgical navigation technologies. However, the effect of robotic intraoperative screw size and trajectory templating remains unclear. The purpose of this study was to compare pedicle screw sizes and accuracy of placement using robotic navigation (RN) versus skin-based intraoperative navigation (ION) alone in minimally invasive lumbar fusion procedures.METHODS: A retrospective cohort study was conducted using a single-institution registry of spine procedures performed over a 4-year period. Patients who underwent 1- or 2-level primary or revision minimally invasive surgery (MIS)-transforaminal lumbar interbody fusion (TLIF) with pedicle screw placement, via either robotic assistance or surgical navigation alone, were included. Demographic, surgical, and radiographic data were collected. Pedicle screw type, quantity, length, diameter, and the presence of endplate breach or facet joint violation were assessed. Statistical analysis using the Student t-test and chi-square test was performed to evaluate the differences in pedicle screw sizes and the accuracy of placement between both groups.RESULTS: Overall, 222 patients were included, of whom 92 underwent RN and 130 underwent ION MIS-TLIF. A total of 403 and 534 pedicle screws were placed with RN and ION, respectively. The mean screw diameters were 7.25 ± 0.81 mm and 6.72 ± 0.49 mm (p < 0.001) for the RN and ION groups, respectively. The mean screw length was 48.4 ± 4.48 mm in the RN group and 45.6 ± 3.46 mm in the ION group (p < 0.001). The rates of "ideal" pedicle screws in the RN and ION groups were comparable at 88.5% and 88.4% (p = 0.969), respectively. The overall screw placement was also similar. The RN cohort had 63.7% screws rated as good and 31.4% as acceptable, while 66.1% of ION-placed screws had good placement and 28.7% had acceptable placement (p = 0.661 and p = 0.595, respectively). There was a significant reduction in high-grade breaches in the RN group (0%, n = 0) compared with the ION group (1.2%, n = 17, p = 0.05).CONCLUSIONS: The results of this study suggest that robotic assistance allows for placement of screws with greater screw diameter and length compared with surgical navigation alone, although with similarly high accuracy. These findings have implied that robotic platforms may allow for safe placement of the "optimal screw," maximizing construct stability and, thus, the ability to obtain a successful fusion.