Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery

被引:168
作者
Molliqaj, Granit [1 ]
Schatlo, Bawarjan [2 ]
Alaid, Awad [2 ]
Solomiichuk, Volodymyr [2 ]
Rohde, Veit [2 ]
Schaller, Karl [1 ]
Tessitore, Enrico [1 ]
机构
[1] Univ Geneva, Geneva Univ Hosp, Fac Med, Dept Neurosurg, Geneva, Switzerland
[2] Georg August Univ Gottingen, Gottingen Univ Hosp, Dept Neurosurg, Gottingen, Germany
关键词
robotic surgery; spinal fusion; pedicle screw; spine instrumentation; computer-assisted surgery; LUMBAR SPINE; PLACEMENT; FIXATION; GUIDANCE;
D O I
10.3171/2017.3.FOCUS179
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE The quest to improve the safety and accuracy and decrease the invasiveness of pedicle screw placement in spine surgery has led to a markedly increased interest in robotic technology. The SpineAssist from Mazor is one of the most widely distributed robotic systems. The aim of this study was to compare the accuracy of robot-guided and conventional freehand fluoroscopy-guided pedicle screw placement in thoracolumbar surgery. METHODS This study is a retrospective series of 169 patients (83 women [49%]) who underwent placement of pedicle screw instrumentation from 2007 to 2015 in 2 reference centers. Pathological entities included degenerative disorders, tumors, and traumatic cases. In the robot-assisted cohort (98 patients, 439 screws), pedicle screws were inserted with robotic assistance. In the freehand fluoroscopy-guided cohort (71 patients, 441 screws), screws were inserted using anatomical landmarks and lateral fluoroscopic guidance. Patients treated before 2009 were included in the fluoroscopy cohort, whereas those treated since mid-2009 (when the robot was acquired) were included in the robot cohort. Since then, the decision to operate using robotic assistance or conventional freehand technique has been based on surgeon preference and logistics. The accuracy of screw placement was assessed based on the Gertzbein-Robbins scale by a neuroradiologist blinded to treatment group. The radiological slice with the largest visible deviation from the pedicle was chosen for grading. A pedicle breach of 2 mm or less was deemed acceptable (Grades A and B) while deviations greater than 2 mm (Grades C, D, and E) were classified as misplacements. RESULTS In the robot-assisted cohort, a perfect trajectory (Grade A) was observed for 366 screws (83.4%). The remaining screws were Grades B (n = 44 [10%]), C (n = 15 [3.4%]), D (n = 8 [1.8%]), and E (n = 6 [1.4%]). In the fluoroscopy-guided group, a completely intrapedicular course graded as A was found in 76% (n = 335). The remaining screws were Grades B (n = 57 [12.9%]), C (n = 29 [6.6%]), D (n = 12 [2.7%]), and E (n = 8 [1.8%]). The proportion of non-misplaced screws (corresponding to Gertzbein-Robbins Grades A and B) was higher in the robot-assisted group (93.4%) than the freehand fluoroscopy group (88.9%) (p = 0.005). CONCLUSIONS The authors' retrospective case review found that robot-guided pedicle screw placement is a safe, useful, and potentially more accurate alternative to the conventional freehand technique for the placement of thoracolumbar spinal instrumentation.
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页数:5
相关论文
共 20 条
[1]   Clinical Acceptance and Accuracy Assessment of Spinal Implants Guided With SpineAssist Surgical Robot Retrospective Study [J].
Devito, Dennis P. ;
Kaplan, Leon ;
Dietl, Rupert ;
Pfeiffer, Michael ;
Horne, Dale ;
Silberstein, Boris ;
Hardenbrook, Mitchell ;
Kiriyanthan, George ;
Barzilay, Yair ;
Bruskin, Alexander ;
Sackerer, Dieter ;
Alexandrovsky, Vitali ;
Stueer, Carsten ;
Burger, Ralf ;
Maeurer, Johannes ;
Gordon, Donald G. ;
Schoenmayr, Robert ;
Friedlander, Alon ;
Knoller, Nachshon ;
Schmieder, Kirsten ;
Pechlivanis, Ioannis ;
Kim, In-Se ;
Meyer, Bernhard ;
Shoham, Moshe .
SPINE, 2010, 35 (24) :2109-2115
[2]  
Devito DP, 2011, SPINE, V36, P91
[3]   The use of pedicle-screw internal fixation for the operative treatment of spinal disorders [J].
Gaines, RW .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2000, 82A (10) :1458-1476
[4]   Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws [J].
Gautschi, Oliver P. ;
Schatlo, Bawarjan ;
Schaller, Karl ;
Tessitore, Enrico .
NEUROSURGICAL FOCUS, 2011, 31 (04)
[5]   ACCURACY OF PEDICULAR SCREW PLACEMENT INVIVO [J].
GERTZBEIN, SD ;
ROBBINS, SE .
SPINE, 1990, 15 (01) :11-14
[6]   Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients [J].
Hu, Xiaobang ;
Ohnmeiss, Donna D. ;
Lieberman, Isador H. .
EUROPEAN SPINE JOURNAL, 2013, 22 (03) :661-666
[7]  
Hyun SJ, 2016, SPINE PHILA PA 1976
[8]   Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement [J].
Kantelhardt, Sven Rainer ;
Martinez, Ramon ;
Baerwinkel, Stefan ;
Burger, Ralf ;
Giese, Alf ;
Rohde, Veit .
EUROPEAN SPINE JOURNAL, 2011, 20 (06) :860-868
[9]  
Kim HJ, 2016, INT J MED ROBOT
[10]   Monitoring the Quality of Robot-Assisted Pedicle Screw Fixation in the Lumbar Spine by Using a Cumulative Summation Test [J].
Kim, Ho-Joong ;
Lee, Seung Hoo ;
Chang, Bong-Soon ;
Lee, Choon-Ki ;
Lim, Teck Onn ;
Hoo, Ling Ping ;
Yi, Je-Min ;
Yeom, Jin S. .
SPINE, 2015, 40 (02) :87-94