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BMC Surgery

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Open Access 01-12-2022 | Research

Comparison of accuracy and safety between second-generation TiRobot-assisted and free-hand thoracolumbar pedicle screw placement

Authors: Kai Yan, Qi Zhang, Wei Tian

Published in: BMC Surgery | Issue 1/2022

Abstract

Background

Robot-assisted spine surgery aims to improve the accuracy of screw placement. We compared the accuracy and safety between a novel robot and free hand in thoracolumbar pedicle screw placement.

Methods

Eighty patients scheduled to undergo robot-assisted (40 patients) and free-hand (40 patients) pedicle screw placement were included. The patients’ demographic characteristics, radiographic accuracy, and perioperative outcomes were compared. The accuracy of screw placement was based on cortical violation and screw deviation. Safety outcomes mainly included operative time, blood loss, revision, and complications.

Results

A total of 178 and 172 screws were placed in the robot-assisted and free-hand groups, respectively. The rate of perfect screw position (grade A) was higher in the robot-assisted group than in the free-hand group (91.0% vs. 75.6%; P < 0.001). The rate of clinically acceptable screw position (grades A and B) was also higher in the robot-assisted group than in the free-hand group (99.4% vs. 90.1%; P < 0.001). The robot-assisted group had significantly lower screw deviation than the free-hand group [1.46 (0.94, 1.95) mm vs. 2.48 (1.09, 3.74) mm, P < 0.001]. There was no robot abandonment in the robot-assisted group. No revision was required in any of the groups.

Conclusions

Robot-assisted pedicle screw placement is more accurate than free-hand placement. The second-generation TiRobot–assisted thoracolumbar pedicle screw placement is an accurate and safe procedure.

Trial registration retrospectively registered

Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res. 1986;203:7–17.CrossRef

Vaccaro AR, Garfin SR. Pedicle-screw fixation in the lumbar spine. J Am Acad Orthop Surg. 1995;3(5):263–74. https://doi.org/10.5435/00124635-199509000-00002.CrossRefPubMed

Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am. 2000;82(10):1458–76. https://doi.org/10.2106/00004623-200010000-00013.CrossRefPubMed

Marchesi D, Schneider E, Glauser P, Aebi M. Morphometric analysis of the thoracolumbar and lumbar pedicles, anatomo-radiologic study. Surg Radiol Anat. 1988;10(4):317–22. https://doi.org/10.1007/bf02107905.CrossRefPubMed

Jutte PC, Castelein RM. Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J. 2002;11(6):594–8. https://doi.org/10.1007/s00586-002-0469-8.CrossRefPubMed

Coe JD, Arlet V, Donaldson W, et al. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976). 2006;31(3):345–9. https://doi.org/10.1097/01.brs.0000197188.76369.13.CrossRef

Tian W. Robot-assisted posterior C1–2 transarticular screw fixation for atlantoaxial instability: a case report. Spine (Phila Pa 1976). 2016;41(Suppl 19):B2–5. https://doi.org/10.1097/BRS.0000000000001674.CrossRef

Tian W, Wang H, Liu YJ. Robot-assisted anterior odontoid screw fixation: a case report. Orthop Surg. 2016;8(3):400–4. https://doi.org/10.1111/os.12266.CrossRefPubMedPubMedCentral

Le X, Tian W, Shi Z, et al. Robot-assisted versus fluoroscopy-assisted cortical bone trajectory screw instrumentation in lumbar spinal surgery: a matched-cohort comparison. World Neurosurg. 2018;120:e745–51. https://doi.org/10.1016/j.wneu.2018.08.157.CrossRefPubMed

10.

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;30(5):615–22. https://doi.org/10.3171/2018.10.SPINE18487.CrossRef

11.

Wu JY, Yuan Q, Liu YJ, Sun YQ, Zhang Y, Tian W. Robot-assisted percutaneous transfacet screw fixation supplementing oblique lateral interbody fusion procedure: accuracy and safety evaluation of this novel minimally invasive technique. Orthop Surg. 2019;11(1):25–33. https://doi.org/10.1111/os.12428.CrossRefPubMedPubMedCentral

12.

Zhang Q, Han XG, Xu YF, et al. Robot-assisted versus fluoroscopy-guided pedicle screw placement in transforaminal lumbar interbody fusion for lumbar degenerative disease. World Neurosurg. 2019;125:e429–34. https://doi.org/10.1016/j.wneu.2019.01.097.CrossRefPubMed

13.

Fan M, Liu Y, He D, et al. Improved accuracy of cervical spinal surgery with robot-assisted screw insertion: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2020;45(5):285–91. https://doi.org/10.1097/BRS.0000000000003258.CrossRef

14.

Feng S, Tian W, Wei Y. Clinical effects of oblique lateral interbody fusion by conventional open versus percutaneous robot-assisted minimally invasive pedicle screw placement in elderly patients. Orthop Surg. 2020;12(1):86–93. https://doi.org/10.1111/os.12587.CrossRefPubMed

15.

Zhang Q, Fan MX, Han XG, et al. Risk factors of unsatisfactory robot-assisted pedicle screw placement: a case-control study. Neurospine. 2021;18(4):839–44. https://doi.org/10.14245/ns.2142560.180.CrossRefPubMedPubMedCentral

16.

Tian W, Liu YJ, Liu B, et al. Guideline for thoracolumbar pedicle screw placement assisted by orthopaedic surgical robot. Orthop Surg. 2019;11(2):153–9. https://doi.org/10.1111/os.12453.CrossRefPubMedPubMedCentral

17.

Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976). 1990;15(1):11–4. https://doi.org/10.1097/00007632-199001000-00004.CrossRef

18.

Fatima N, Massaad E, Hadzipasic M, Shankar GM, Shin JH. Safety and accuracy of robot-assisted placement of pedicle screws compared to conventional free-hand technique: a systematic review and meta-analysis. Spine J. 2021;21(2):181–92. https://doi.org/10.1016/j.spinee.2020.09.007.CrossRefPubMed

19.

Wallace DJ, Vardiman AB, Booher GA, et al. Navigated robotic assistance improves pedicle screw accuracy in minimally invasive surgery of the lumbosacral spine: 600 pedicle screws in a single institution. Int J Med Robot. 2020;16(1): e2054. https://doi.org/10.1002/rcs.2054.CrossRefPubMed

20.

Panchmatia JR, Vaccaro AR, Wang W, Harris JA, Bucklen BS. Lumbar percutaneous pedicle screw breach rates: a comparison of robotic navigation platform versus conventional techniques. Clin Spine Surg. 2020. https://doi.org/10.1097/BSD.0000000000000963.CrossRefPubMed

21.

Su XJ, Lv ZD, Chen Z, et al. Comparison of accuracy and clinical outcomes of robot-assisted versus fluoroscopy-guided pedicle screw placement in posterior cervical surgery. Global Spine J. 2020. https://doi.org/10.1177/2192568220960406.CrossRefPubMedPubMedCentral

22.

Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions: a randomized controlled trial. Spine (Phila Pa 1976). 2017;42(6):353–8. https://doi.org/10.1097/BRS.0000000000001778.CrossRef

23.

Lee NJ, Buchanan IA, Zuckermann SL, et al. What is the comparison in robot time per screw, radiation exposure, robot abandonment, screw accuracy, and clinical outcomes between percutaneous and open robot-assisted short lumbar fusion? A multicenter, propensity-matched analysis of 310 patients. Spine Phila Pa 1976. 2022;47(1):42–8. https://doi.org/10.1097/BRS.0000000000004132.CrossRefPubMed

Title: Comparison of accuracy and safety between second-generation TiRobot-assisted and free-hand thoracolumbar pedicle screw placement
Authors: Kai Yan
Qi Zhang
Wei Tian
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-022-01723-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of accuracy and safety between second-generation TiRobot-assisted and free-hand thoracolumbar pedicle screw placement

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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