Preliminary comparative study of spinal robot-assisted pedicle screw placement using different surgical approaches_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YU Yang , WU Bing , SONG Kai , SONG Keran , CHI Pengfei , LIU Haoming ,  WANG Zheng

Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100071, P. R. China;

Corresponding author：

WANG Zheng, Email: wangzheng301@163.com

Keywords：

Spinal robot; assisted pedicle screw placement; posterior median approach; intermuscular approach

DOI：

10.7507/1002-1892.202404112

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the effectiveness of spinal robot-assisted pedicle screw placement through different surgical approaches and to guide the clinical selection of appropriate robot-assisted surgical approaches. Methods The clinical data of 14 patients with thoracolumbar vertebral diseases who met the selection criteria between January 2023 and August 2023 were retrospectively analyzed, and all of them underwent pedicle screw placement under assistant of the Mazor X spinal surgery robot through different surgical approaches. The patients were divided into posterior median approach (PMA) group (n=6) and intermuscular approach (IMA) group (n=8) according to the surgical approaches, and there was no significant difference in age, gender, body mass index, disease type, and fixed segment between the two groups (P>0.05). The operation time, intraoperative blood loss, screw-related complications, and reoperation rate were recorded and compared between the two groups; the inclination angle of the screw, the distance between the screw and the midline, and the caudal inclination angle of the screw were measured based on X-ray films at immediate after operation. Results There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). There was no screw-related complication such as nerve injury in both groups, and no patients underwent secondary surgery. At immediate after operation, the inclination angle of the screw, the distance between the screw and the midline, and the caudal inclination angle of the screw in the IMA group were significantly greater than those in the PMA group (P<0.05). Conclusion There are differences in the position and inclination angle of screws placed with robot-assisted surgery through different surgical approaches, which may be due to the obstruction of the screw path by soft tissues such as skin and muscles. When using spinal robot-assisted surgery, selecting the appropriate surgical approach for different diseases can make the treatment more reasonable and effective.

Citation： YU Yang, WU Bing, SONG Kai, SONG Keran, CHI Pengfei, LIU Haoming, WANG Zheng. Preliminary comparative study of spinal robot-assisted pedicle screw placement using different surgical approaches. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(8): 923-928. doi: 10.7507/1002-1892.202404112 Copy

1.	Kochanski RB, Lombardi JM, Laratta JL, et al. Image-guided navigation and robotics in spine surgery. Neurosurgery, 2019, 84(6): 1179-1189.
2.	Zhang Q, Han XG, Xu YF, et al. Robotic navigation during spine surgery. Expert Rev Med Devices, 2020, 17(1): 27-32.
3.	Shahi P, Subramanian T, Araghi K, et al. Comparison of robotics and navigation for clinical outcomes after minimally invasive lumbar fusion. Spine (Phila Pa 1976), 2023, 48(19): 1342-1347.
4.	Kim HJ, Lee SH, Chang BS, et al. Monitoring the quality of robot-assisted pedicle screw fixation in the lumbar spine by using a cumulative summation test. Spine (Phila Pa 1976), 2015, 40(2): 87-94.
5.	Zhang RJ, Zhou LP, Zhang L, et al. Safety and risk factors of TINAVI robot-assisted percutaneous pedicle screw placement in spinal surgery. J Orthop Surg Res, 2022, 17(1): 379. doi: 10.1186/s13018-022-03271-6.
6.	Stüer C, Ringel F, Stoffel M, et al. Robotic technology in spine surgery: current applications and future developments. Acta Neurochir Suppl, 2011, 109: 241-245.
7.	Stephens ME, O’Neal CM, Westrup AM, et al. Utility of machine learning algorithms in degenerative cervical and lumbar spine disease: a systematic review. Neurosurg Rev, 2022, 45(2): 965-978.
8.	Hu X, Ohnmeiss DD, Lieberman IH. Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients. Eur Spine J, 2013, 22(3): 661-666.
9.	Chenin L, Peltier J, Lefranc M. Minimally invasive transforaminal lumbar interbody fusion with the ROSA(TM) Spine robot and intraoperative flat-panel CT guidance. Acta Neurochir (Wien), 2016, 158(6): 1125-1128.
10.	Kantelhardt SR, Martinez R, Baerwinkel S, et al. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J, 2011, 20(6): 860-868.
11.	Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
12.	Han XG, Tang GQ, Han X, et al. Comparison of outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion and oblique lumbar interbody fusion in single-level lumbar spondylolisthesis. Orthop Surg, 2021, 13(7): 2093-2101.
13.	Fan M, Fang Y, Zhang Q, et al. A prospective cohort study of the accuracy and safety of robot-assisted minimally invasive spinal surgery. BMC Surg, 2022, 22(1): 47. doi: 10.1186/s12893-022-01503-4.
14.	Bettag C, Jann T, Rohde V, et al. Robot-assisted spinal augmentation procedures: is it worth the increased effort? Eur Spine J, 2023, 32(11): 3927-3932.
15.	Zhou S, Li B, Wang P, et al. Robot and working tube-assisted invasion-controlled surgery for spinal metastases. Front Surg, 2023, 10: 1041562. doi: 10.3389/fsurg.2023.1041562.
16.	Feng F, Chen X, Liu Z, et al. Learning curve of junior surgeons in robot-assisted pedicle screw placement: a comparative cohort study. Eur Spine J, 2024, 33(1): 314-323.

1. Kochanski RB, Lombardi JM, Laratta JL, et al. Image-guided navigation and robotics in spine surgery. Neurosurgery, 2019, 84(6): 1179-1189.
2. Zhang Q, Han XG, Xu YF, et al. Robotic navigation during spine surgery. Expert Rev Med Devices, 2020, 17(1): 27-32.
3. Shahi P, Subramanian T, Araghi K, et al. Comparison of robotics and navigation for clinical outcomes after minimally invasive lumbar fusion. Spine (Phila Pa 1976), 2023, 48(19): 1342-1347.
4. Kim HJ, Lee SH, Chang BS, et al. Monitoring the quality of robot-assisted pedicle screw fixation in the lumbar spine by using a cumulative summation test. Spine (Phila Pa 1976), 2015, 40(2): 87-94.
5. Zhang RJ, Zhou LP, Zhang L, et al. Safety and risk factors of TINAVI robot-assisted percutaneous pedicle screw placement in spinal surgery. J Orthop Surg Res, 2022, 17(1): 379. doi: 10.1186/s13018-022-03271-6.
6. Stüer C, Ringel F, Stoffel M, et al. Robotic technology in spine surgery: current applications and future developments. Acta Neurochir Suppl, 2011, 109: 241-245.
7. Stephens ME, O’Neal CM, Westrup AM, et al. Utility of machine learning algorithms in degenerative cervical and lumbar spine disease: a systematic review. Neurosurg Rev, 2022, 45(2): 965-978.
8. Hu X, Ohnmeiss DD, Lieberman IH. Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients. Eur Spine J, 2013, 22(3): 661-666.
9. Chenin L, Peltier J, Lefranc M. Minimally invasive transforaminal lumbar interbody fusion with the ROSA(TM) Spine robot and intraoperative flat-panel CT guidance. Acta Neurochir (Wien), 2016, 158(6): 1125-1128.
10. Kantelhardt SR, Martinez R, Baerwinkel S, et al. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J, 2011, 20(6): 860-868.
11. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
12. Han XG, Tang GQ, Han X, et al. Comparison of outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion and oblique lumbar interbody fusion in single-level lumbar spondylolisthesis. Orthop Surg, 2021, 13(7): 2093-2101.
13. Fan M, Fang Y, Zhang Q, et al. A prospective cohort study of the accuracy and safety of robot-assisted minimally invasive spinal surgery. BMC Surg, 2022, 22(1): 47. doi: 10.1186/s12893-022-01503-4.
14. Bettag C, Jann T, Rohde V, et al. Robot-assisted spinal augmentation procedures: is it worth the increased effort? Eur Spine J, 2023, 32(11): 3927-3932.
15. Zhou S, Li B, Wang P, et al. Robot and working tube-assisted invasion-controlled surgery for spinal metastases. Front Surg, 2023, 10: 1041562. doi: 10.3389/fsurg.2023.1041562.
16. Feng F, Chen X, Liu Z, et al. Learning curve of junior surgeons in robot-assisted pedicle screw placement: a comparative cohort study. Eur Spine J, 2024, 33(1): 314-323.

Chinese Journal of Reparative and Reconstructive Surgery

Preliminary comparative study of spinal robot-assisted pedicle screw placement using different surgical approaches

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content