A comparative study of robot-assisted and freehand pedicle screw placement in upper thoracic surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Fei , HU Jiang , TANG Liuyi , WAN Lun , YU Yang , TANG Zhi ,  ZHANG Wei

Department of Orthopaedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu Sichuan, 610072, P.R.China;

Corresponding author：

ZHANG Wei, Email: zhangwspine@163.com

Keywords：

Orthopedic robot system; upper thoracic vertebra; pedicle screw

DOI：

10.7507/1002-1892.202004072

Video：

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Objective To compare the safety and accuracy of pedicle screw placement assisted by robot system with freehand pedicle screw placement in upper thoracic surgery.Methods Between December 2017 and December 2019, 39 cases with upper thoracic pedicle screw internal fixation were included in the study, including 19 cases in robot group (group A, robot assisted pedicle screw placement) and 20 cases in freehand group (group B, freehand pedicle screw placement). There were 104 screws implanted in group A and 108 screws in group B. There was no significant difference in age, gender composition, body mass index, disease type, number of screws implanted, and segmental distribution between the two groups (P>0.05). The operation time, intraoperative blood loss, and postoperative drainage were recorded and compared between the two groups. CT scan was performed in all patients at 2 days after operation to evaluate the screw accuracy based on the Gertzbein-Robbins grading standard.Results The operation time of group A was significantly longer than that in group B (t=2.759, P=0.009). There was no significant difference in intraoperative blood loss and postoperative drainage between the two groups (t=−0.796, P=0.431; t=−0.814, P=0.421). At 2 days after operation, according to Gertzbein-Robbins grading standard, the accuracy of pedicle screw implantation in group A were grade A in 94 screws, grade B in 9 screws, and grade C in 1 screw; and in group B were grade A in 72 screws, grade B in 26 screws, grade C in 9 screws, and grade D in 1 screw; the difference between the two groups was significant (Z=4.257, P=0.000). The accuracy rate of group A was 99.04%, and that of group B was 90.74%, showing significant difference (χ²=7.415, P=0.006).Conclusion Compared with traditional freehand pedicle screw placement, robot-assisted pedicle screw placement significantly improves the accuracy and safety of screw placement without increasing the bleeding and postoperative drainage.

Citation： WANG Fei, HU Jiang, TANG Liuyi, WAN Lun, YU Yang, TANG Zhi, ZHANG Wei. A comparative study of robot-assisted and freehand pedicle screw placement in upper thoracic surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1521-1525. doi: 10.7507/1002-1892.202004072 Copy

1.	Perdomo-Pantoja A, Ishida W, Zygourakis C, et al. Accuracy of current techniques for placement of pedicle screws in the spine: A comprehensive systematic review and meta-analysis of 51, 161 screws. World Neurosurg, 2019, 126: 664-678.
2.	Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019. doi: 10.3171/2018.10.SPINE18487.
3.	田伟, 范明星, 韩晓光, 等. 机器人辅助与传统透视辅助脊柱椎弓根螺钉内固定的临床对比研究. 骨科临床与研究杂志, 2016, 1(1): 4-10.
4.	田野, 张嘉男, 陈浩, 等. 脊柱机器人与传统透视辅助下微创经皮复位内固定术治疗单节段无神经症状胸腰椎骨折对比研究. 中国修复重建外科杂志, 2020, 34(1): 69-75.
5.	杨俊松, 郝定均, 刘团江, 等. 脊柱机器人与透视辅助下经皮植钉治疗腰椎滑脱症中植钉精度的对比研究. 中国修复重建外科杂志, 2018, 32(11): 1371-1376.
6.	Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: A meta-analysis. Spine (Phila Pa 1976), 2007, 32(3): E111-120.
7.	Tian NF, Xu HZ. Image-guided pedicle screw insertion accuracy: A meta-analysis. Int Orthop, 2009, 33(4): 895-903.
8.	Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
9.	Heintel TM, Dannigkeit S, Fenwick A, et al. How safe is minimally invasive pedicle screw placement for treatment of thoracolumbar spine fractures? Eur Spine J, 2017, 26(5): 1515-1524.
10.	Kim HJ, Jung WI, Chang BS, et al. A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery. Int J Med Robot, 2017, 13(3). doi: 10.1002/rcs.1779.
11.	Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with spine assist surgical robot: Retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
12.	Molliqaj G, Schatlo B, Alaid A, et al. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus, 2017, 42(5): E14.
13.	Macke JJ, Woo R, Varich L. Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population. J Robot Surg, 2016, 10(2): 145-150.
14.	Siccoli A, Klukowska AM, Schröder ML, et al. A systematic review and meta-analysis of perioperative parameters in robot-guided, navigated, and freehand thoracolumbar pedicle screw instrumentation. World Neurosurg, 2019, 127: 576-587.
15.	D’Souza M, Gendreau J, Feng A, et al. Robotic-assisted spine surgery: history, efficacy, cost, and future trends. Robot Surg, 2019, 6: 9-23.
16.	Yu L, Chen X, Margalit A, et al. Robot-assisted vs freehand pedicle screw fixation in spine surgery-a systematic review and a meta-analysis of comparative studies. Int J Med Robot, 2018, 14(3): e1892.
17.	van Dijk JD, van den Ende RP, Stramigioli S, et al. Clinical pedicle screw accuracy and deviation from planning in robot-guided spine surgery: Robot-guided pedicle screw accuracy. Spine (Phila Pa 1976), 2015, 40(17): E986-991.
18.	Solomiichuk V, Fleischhammer J, Molliqaj G, et al. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison. Neurosurg Focus, 2017, 42(5): E13.
19.	Siddiqui MI, Wallace DJ, Salazar LM, et al. Robot-assisted pedicle screw placement: learning curve experience. World Neurosurg, 2019, 130: e417-e422.
20.	Kam JKT, Gan C, Dimou S, et al. Learning curve for robot-assisted percutaneous pedicle screw placement in thoracolumbar surgery. Asian Spine J, 2019, 13(6): 920-927.
21.	Tian W, Liu YJ, Liu B, et al. Guideline for thoracolumbar pedicle screw placement assisted by orthopaedic surgical robot. Orthop Surg, 2019, 11(2): 153-159.

1. Perdomo-Pantoja A, Ishida W, Zygourakis C, et al. Accuracy of current techniques for placement of pedicle screws in the spine: A comprehensive systematic review and meta-analysis of 51, 161 screws. World Neurosurg, 2019, 126: 664-678.
2. Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019. doi: 10.3171/2018.10.SPINE18487.
3. 田伟, 范明星, 韩晓光, 等. 机器人辅助与传统透视辅助脊柱椎弓根螺钉内固定的临床对比研究. 骨科临床与研究杂志, 2016, 1(1): 4-10.
4. 田野, 张嘉男, 陈浩, 等. 脊柱机器人与传统透视辅助下微创经皮复位内固定术治疗单节段无神经症状胸腰椎骨折对比研究. 中国修复重建外科杂志, 2020, 34(1): 69-75.
5. 杨俊松, 郝定均, 刘团江, 等. 脊柱机器人与透视辅助下经皮植钉治疗腰椎滑脱症中植钉精度的对比研究. 中国修复重建外科杂志, 2018, 32(11): 1371-1376.
6. Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: A meta-analysis. Spine (Phila Pa 1976), 2007, 32(3): E111-120.
7. Tian NF, Xu HZ. Image-guided pedicle screw insertion accuracy: A meta-analysis. Int Orthop, 2009, 33(4): 895-903.
8. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
9. Heintel TM, Dannigkeit S, Fenwick A, et al. How safe is minimally invasive pedicle screw placement for treatment of thoracolumbar spine fractures? Eur Spine J, 2017, 26(5): 1515-1524.
10. Kim HJ, Jung WI, Chang BS, et al. A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery. Int J Med Robot, 2017, 13(3). doi: 10.1002/rcs.1779.
11. Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with spine assist surgical robot: Retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
12. Molliqaj G, Schatlo B, Alaid A, et al. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus, 2017, 42(5): E14.
13. Macke JJ, Woo R, Varich L. Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population. J Robot Surg, 2016, 10(2): 145-150.
14. Siccoli A, Klukowska AM, Schröder ML, et al. A systematic review and meta-analysis of perioperative parameters in robot-guided, navigated, and freehand thoracolumbar pedicle screw instrumentation. World Neurosurg, 2019, 127: 576-587.
15. D’Souza M, Gendreau J, Feng A, et al. Robotic-assisted spine surgery: history, efficacy, cost, and future trends. Robot Surg, 2019, 6: 9-23.
16. Yu L, Chen X, Margalit A, et al. Robot-assisted vs freehand pedicle screw fixation in spine surgery-a systematic review and a meta-analysis of comparative studies. Int J Med Robot, 2018, 14(3): e1892.
17. van Dijk JD, van den Ende RP, Stramigioli S, et al. Clinical pedicle screw accuracy and deviation from planning in robot-guided spine surgery: Robot-guided pedicle screw accuracy. Spine (Phila Pa 1976), 2015, 40(17): E986-991.
18. Solomiichuk V, Fleischhammer J, Molliqaj G, et al. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison. Neurosurg Focus, 2017, 42(5): E13.
19. Siddiqui MI, Wallace DJ, Salazar LM, et al. Robot-assisted pedicle screw placement: learning curve experience. World Neurosurg, 2019, 130: e417-e422.
20. Kam JKT, Gan C, Dimou S, et al. Learning curve for robot-assisted percutaneous pedicle screw placement in thoracolumbar surgery. Asian Spine J, 2019, 13(6): 920-927.
21. Tian W, Liu YJ, Liu B, et al. Guideline for thoracolumbar pedicle screw placement assisted by orthopaedic surgical robot. Orthop Surg, 2019, 11(2): 153-159.

Chinese Journal of Reparative and Reconstructive Surgery

A comparative study of robot-assisted and freehand pedicle screw placement in upper thoracic surgery

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