Effectiveness of robot-guided percutaneous fixation and decompression via small incision for advanced thoracolumbar metastases_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Jiahong , LIN Shu , TANG Liuyi , HU Jiang , WAN Lun , ZHANG Kun ,  LIANG Weimin , WANG Shan

Department of Orthopedics, Sichuan Academy of Medical Science, People’s Hospital of Sichuan Province, Chengdu Sichuan, 610072, P. R. China;

Corresponding author：

LIANG Weimin, Email: liangbsb@126.com

Keywords：

Orthopedic robot; thoracolumbar spine; metastases; percutaneous fixation; minimal invasive surgery; open surgery

DOI：

10.7507/1002-1892.202305040

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Objective To evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases. Methods A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups (P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading. Results During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups (P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group (P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups (P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation (P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation (P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group (P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group (P>0.05). Median overall survival time was 13 months [95%CI (10.858, 15.142) months] in the robot-guided group and 15 months [95%CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups (χ²=0.561, P=0.454) . Conclusion Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.

Citation： LI Jiahong, LIN Shu, TANG Liuyi, HU Jiang, WAN Lun, ZHANG Kun, LIANG Weimin, WANG Shan. Effectiveness of robot-guided percutaneous fixation and decompression via small incision for advanced thoracolumbar metastases. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(9): 1113-1118. doi: 10.7507/1002-1892.202305040 Copy

1.	Sullivan PZ, Niu T, Abinader JF, et al. Evolution of surgical treatment of metastatic spine tumors. J Neurooncol, 2022, 157(2): 277-283.
2.	Orenday-Barraza JM, Cavagnaro MJ, Avila MJ, et al. 10-year trends in the surgical management of patients with spinal metastases: a scoping review. World Neurosurg, 2022, 157: 170-186.
3.	肖渝, 夏萍, 张漾杰, 等. 微创技术在脊柱肿瘤中的研究进展. 肿瘤预防与治疗, 2023, 36(2): 162-167.
4.	赵雄伟, 曹叙勇, 刘耀升. 脊柱转移瘤微创手术的研究进展. 中华骨与关节外科杂志, 2022, 15(7): 554-560.
5.	田伟, 范明星, 张琦, 等. 中国骨科手术机器人的发展. 应用力学学报, 2023, 40(1): 1-6.
6.	朱振中, 郑国焱, 张长青. 机器人辅助技术在创伤骨科的发展与临床应用. 中国修复重建外科杂志, 2022, 36(8): 915-922.
7.	孟磊, 张贯林, 李东风, 等.“天玑”骨科手术机器人辅助下经皮椎弓根钉内固定治疗胸腰椎骨折的疗效观察. 中国骨与关节损伤杂志, 2022, 37(7): 705-708.
8.	张同同, 王增平, 王中华, 等. 骨科机器人辅助下脊柱椎弓根螺钉置入准确性与安全性的临床研究. 中国骨伤, 2022, 35(2): 108-112.
9.	Perfetti DC, Kisinde S, Rogers-LaVanne MP, et al. Robotic spine surgery: past, present, and future. Spine (Phila Pa 1976), 2022, 47(13): 909-921.
10.	Lin S, Wang F, Hu J, et al. Comparison of the accuracy and safety of tirobot-assisted and fluoroscopy-assisted percutaneous pedicle screw placement for the treatment of thoracolumbar fractures. Orthop Surg, 2022, 14(11): 2955-2963.
11.	Huang M, Tetreault TA, Vaishnav A, et al. The current state of navigation in robotic spine surgery. Ann Transl Med, 2021, 9(1): 86.
12.	Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976), 2010, 35(22): E1221-E1229.
13.	Bollen L, van der Linden YM, Pondaag W, et al. Prognostic factors associated with survival in patients with symptomatic spinal bone metastases: a retrospective cohort study of 1, 043 patients. Neuro Oncol, 2014, 16(7): 991-998.
14.	Tomita K, Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases. Spine (Phila Pa 1976), 2001, 26(3): 298-306.
15.	Tokuhashi Y, Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976), 2005, 30(19): 2186-2191.
16.	Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
17.	Morgen SS, Hansen LV, Karbo T, et al. Minimal access vs. open spine surgery in patients with metastatic spinal cord compression—A one-center randomized controlled trial. Anticancer Res, 2020, 40(10): 5673-5678.
18.	林书, 胡豇, 万仑, 等. “天玑”骨科机器人辅助下经皮椎弓根螺钉植钉安全性评价. 中国修复重建外科杂志, 2021, 35(7): 813-817.
19.	林书, 胡豇, 万仑, 等. 机器人与透视辅助经皮椎弓根螺钉置入的比较. 中国矫形外科杂志, 2020, 28(20): 1830-1834.
20.	仉建国, 庄乾宇. 脊柱大手术围术期血液管理专家共识. 中国脊柱脊髓杂志, 2022, 32(11): 1049-1056.
21.	Zhu X, Lu J, Xu H, et al. A comparative study between minimally invasive spine surgery and traditional open surgery for patients with spinal metastasis. Spine (Phila Pa 1976), 2021, 46(1): 62-68.
22.	Saadeh YS, Elswick CM, Fateh JA, et al. Analysis of outcomes between traditional open versus mini-open approach in surgical treatment of spinal metastasis. World Neurosurg, 2019, 130: e467-e474.
23.	Hansen-Algenstaedt N, Kwan MK, Algenstaedt P, et al. Comparison between minimally invasive surgery and conventional open surgery for patients with spinal metastasis: a prospective propensity score-matched study. Spine (Phila Pa 1976), 2017, 42(10): 789-797.
24.	Kumar N, Malhotra R, Maharajan K, et al. Metastatic spine tumor surgery: a comparative study of minimally invasive approach using percutaneous pedicle screws fixation versus open approach. Clin Spine Surg, 2017, 30(8): E1015-E1021.
25.	Flynn SC, Eli IM, Ghogawala Z, et al. Minimally invasive surgery for spinal metastasis: a review. World Neurosurg, 2022, 159: e32-e39.
26.	Pranata R, Lim MA, Vania R, et al. Minimal invasive surgery instrumented fusion versus conventional open surgical instrumented fusion for the treatment of spinal metastases: a systematic review and meta-analysis. World Neurosurg, 2021, 148: e264-e274.
27.	Ntilikina Y, Collinet A, Tigan LV, et al. Comparison of open versus minimally invasive surgery in the treatment of thoracolumbar metastases. Orthop Traumatol Surg Res, 2022, 108(4): 103274.

1. Sullivan PZ, Niu T, Abinader JF, et al. Evolution of surgical treatment of metastatic spine tumors. J Neurooncol, 2022, 157(2): 277-283.
2. Orenday-Barraza JM, Cavagnaro MJ, Avila MJ, et al. 10-year trends in the surgical management of patients with spinal metastases: a scoping review. World Neurosurg, 2022, 157: 170-186.
3. 肖渝, 夏萍, 张漾杰, 等. 微创技术在脊柱肿瘤中的研究进展. 肿瘤预防与治疗, 2023, 36(2): 162-167.
4. 赵雄伟, 曹叙勇, 刘耀升. 脊柱转移瘤微创手术的研究进展. 中华骨与关节外科杂志, 2022, 15(7): 554-560.
5. 田伟, 范明星, 张琦, 等. 中国骨科手术机器人的发展. 应用力学学报, 2023, 40(1): 1-6.
6. 朱振中, 郑国焱, 张长青. 机器人辅助技术在创伤骨科的发展与临床应用. 中国修复重建外科杂志, 2022, 36(8): 915-922.
7. 孟磊, 张贯林, 李东风, 等.“天玑”骨科手术机器人辅助下经皮椎弓根钉内固定治疗胸腰椎骨折的疗效观察. 中国骨与关节损伤杂志, 2022, 37(7): 705-708.
8. 张同同, 王增平, 王中华, 等. 骨科机器人辅助下脊柱椎弓根螺钉置入准确性与安全性的临床研究. 中国骨伤, 2022, 35(2): 108-112.
9. Perfetti DC, Kisinde S, Rogers-LaVanne MP, et al. Robotic spine surgery: past, present, and future. Spine (Phila Pa 1976), 2022, 47(13): 909-921.
10. Lin S, Wang F, Hu J, et al. Comparison of the accuracy and safety of tirobot-assisted and fluoroscopy-assisted percutaneous pedicle screw placement for the treatment of thoracolumbar fractures. Orthop Surg, 2022, 14(11): 2955-2963.
11. Huang M, Tetreault TA, Vaishnav A, et al. The current state of navigation in robotic spine surgery. Ann Transl Med, 2021, 9(1): 86.
12. Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976), 2010, 35(22): E1221-E1229.
13. Bollen L, van der Linden YM, Pondaag W, et al. Prognostic factors associated with survival in patients with symptomatic spinal bone metastases: a retrospective cohort study of 1, 043 patients. Neuro Oncol, 2014, 16(7): 991-998.
14. Tomita K, Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases. Spine (Phila Pa 1976), 2001, 26(3): 298-306.
15. Tokuhashi Y, Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976), 2005, 30(19): 2186-2191.
16. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
17. Morgen SS, Hansen LV, Karbo T, et al. Minimal access vs. open spine surgery in patients with metastatic spinal cord compression—A one-center randomized controlled trial. Anticancer Res, 2020, 40(10): 5673-5678.
18. 林书, 胡豇, 万仑, 等. “天玑”骨科机器人辅助下经皮椎弓根螺钉植钉安全性评价. 中国修复重建外科杂志, 2021, 35(7): 813-817.
19. 林书, 胡豇, 万仑, 等. 机器人与透视辅助经皮椎弓根螺钉置入的比较. 中国矫形外科杂志, 2020, 28(20): 1830-1834.
20. 仉建国, 庄乾宇. 脊柱大手术围术期血液管理专家共识. 中国脊柱脊髓杂志, 2022, 32(11): 1049-1056.
21. Zhu X, Lu J, Xu H, et al. A comparative study between minimally invasive spine surgery and traditional open surgery for patients with spinal metastasis. Spine (Phila Pa 1976), 2021, 46(1): 62-68.
22. Saadeh YS, Elswick CM, Fateh JA, et al. Analysis of outcomes between traditional open versus mini-open approach in surgical treatment of spinal metastasis. World Neurosurg, 2019, 130: e467-e474.
23. Hansen-Algenstaedt N, Kwan MK, Algenstaedt P, et al. Comparison between minimally invasive surgery and conventional open surgery for patients with spinal metastasis: a prospective propensity score-matched study. Spine (Phila Pa 1976), 2017, 42(10): 789-797.
24. Kumar N, Malhotra R, Maharajan K, et al. Metastatic spine tumor surgery: a comparative study of minimally invasive approach using percutaneous pedicle screws fixation versus open approach. Clin Spine Surg, 2017, 30(8): E1015-E1021.
25. Flynn SC, Eli IM, Ghogawala Z, et al. Minimally invasive surgery for spinal metastasis: a review. World Neurosurg, 2022, 159: e32-e39.
26. Pranata R, Lim MA, Vania R, et al. Minimal invasive surgery instrumented fusion versus conventional open surgical instrumented fusion for the treatment of spinal metastases: a systematic review and meta-analysis. World Neurosurg, 2021, 148: e264-e274.
27. Ntilikina Y, Collinet A, Tigan LV, et al. Comparison of open versus minimally invasive surgery in the treatment of thoracolumbar metastases. Orthop Traumatol Surg Res, 2022, 108(4): 103274.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of robot-guided percutaneous fixation and decompression via small incision for advanced thoracolumbar metastases

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