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Open Access 01-12-2022 | Spondylolisthesis | Research article

A prospective cohort study of the accuracy and safety of robot-assisted minimally invasive spinal surgery

Authors: Mingxing Fan, Yanming Fang, Qi Zhang, Jingwei Zhao, Bo Liu, Wei Tian

Published in: BMC Surgery | Issue 1/2022

Abstract

Background

Robot-assisted open surgery (RA-OS) is now commonly used in traditional open-exposure spinal screw placement surgery. With the help of robots, robot-assisted minimally invasive surgery (RA-MIS) can achieve less bleeding and less tissue damage in percutaneous screw insertion. While the research comparing the safety and accuracy of screw placement between RA-MIS and RA-OS is insufficient. This study aims to compare the effects of RA-MIS and RA-OS in thoracic and lumbar spine.

Methods

This was a prospective cohort study evaluating 208 patients undergoing robot-assisted screw insertions from July 2020 to September 2021. Age, BMI, gender, screws accuracy, screws Gertzbein–Robbins grade, small joint invasion and perioperative outcomes (operation time, blood loss, postoperative hospital stay, comorbidity) were collected. A subgroup analysis was also performed according to disease, namely fracture, spondylolisthesis, and disc herniation. Data were analyzed using Stata/MP 14.0. Wilcoxon’s signed rank test, Kruskal–Wallis test and Fisher’s exact test were used for statistical tests and p < 0.05 was considered statistically significant.

Results

A total of 1030 screws were inserted; 368 minimally invasive screws and 662 open screws. The acceptability of screw insertion in the RA-MIS and RA-OS was 97.3% and 95.6% respectively. There was no statistical difference between the RA-MIS group and RA-OS group in age (p = 0.106), gender (p = 0.074), BMI (p = 0.181) and comorbidity (p = 0.203). Compared with RA-OS, RA-MIS had less blood loss (p < 0.001) and shorter postoperative hospital stay (p = 0.008). In the minimally invasive surgery group, the fracture subgroup had smaller screw deviation, less blood loss, and shorter operation time compared with the other subgroups (p < 0.01). Specifically, RA-MIS significantly reduced the postoperative hospital stay of patients with spondylolisthesis compared with RA-OS (p < 0.01).

Conclusion

RA-OS and RA-MIS had equal accuracy and safety. Compared with open surgery, minimally invasive surgery reduced blood loss in each subgroup and shortened the postoperative hospital stay in the spondylolisthesis subgroup. Compared with the other subgroups under minimally invasive surgery, the fracture subgroup had less blood loss and shorter operation time.

Clinical trial registration: NCT04040868. Registered 1 March 2019, https://clinicaltrials.gov/ct2/show/NCT04040868?cond=Accuracy+Study+of+Robot-assisted+Screw+Insertion+in+Spinal+Surgery&draw=2&rank=1.

Archavlis E, Amr N, Kantelhardt SR, et al. Rates of upper facet joint violation in minimally invasive percutaneous and open instrumentation: a comparative cohort study of different insertion techniques. J Neurol Surg A Cent Eur Neurosurg. 2018;79(1):1–8. https://doi.org/10.1055/s-0037-1603631.CrossRefPubMed

Bose B, Wierzbowski LR, Sestokas AK. Neurophysiologic monitoring of spinal nerve root function during instrumented posterior lumbar spine surgery. Spine (Phila Pa 1976). 2002;27(13):1444–50. https://doi.org/10.1097/00007632-200207010-00014.CrossRef

Cui GY, Tian W, He D, et al. Effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion and traditional open surgery in the treatment of lumbar spondylolisthesis. Zhonghua Wai Ke Za Zhi. 2017;55(7):543–8. https://doi.org/10.3760/cma.j.issn.0529-5815.2017.07.013.CrossRefPubMed

El Mansy Y, Migliorini F, Tingart M, et al. Minimally versus conventional-invasive transforaminal lumbar interbody fusion in patients with failed back surgery syndrome. Musculoskelet Surg. 2020. https://doi.org/10.1007/s12306-020-00659-7.CrossRefPubMed

Elgafy H, Hamilton R, Peters N, et al. Critical care of obese patients during and after spine surgery. World J Crit Care Med. 2016;5(1):83–8. https://doi.org/10.5492/wjccm.v5.i1.83.CrossRefPubMedPubMedCentral

Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J. 2012;21(2):247–55. https://doi.org/10.1007/s00586-011-2011-3.CrossRefPubMed

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

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. https://doi.org/10.3171/2018.10.Spine18487.CrossRefPubMed

Harimaya K, Lenke LG, Son-Hing JP, et al. Safety and accuracy of pedicle screws and constructs placed in infantile and juvenile patients. Spine (Phila Pa 1976). 2011;36(20):1645–51. https://doi.org/10.1097/BRS.0b013e318225b8f9.CrossRef

10.

Hayashi D, Roemer FW, Mian A, et al. Imaging features of postoperative complications after spinal surgery and instrumentation. AJR Am J Roentgenol. 2012;199(1):W123-129. https://doi.org/10.2214/ajr.11.6497.CrossRefPubMed

11.

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

12.

Lieberman IH, Kisinde S, Hesselbacher S. Robotic-assisted pedicle screw placement during spine surgery. JBJS Essent Surg Tech. 2020;10(2): e0020. https://doi.org/10.2106/jbjs.St.19.00020.CrossRefPubMedPubMedCentral

13.

Lin S, Hu J, Wan L, et al. Short-term effectiveness comparison between robotic-guided percutaneous minimally invasive pedicle screw internal fixation and traditional open internal fixation in treatment of thoracolumbar fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020;34(1):76–82. https://doi.org/10.7507/1002-1892.201906105.CrossRefPubMed

14.

Minamide A, Yoshida M, Iwahashi H, et al. Minimally invasive decompression surgery for lumbar spinal stenosis with degenerative scoliosis: predictive factors of radiographic and clinical outcomes. J Orthop Sci. 2017;22(3):377–83. https://doi.org/10.1016/j.jos.2016.12.022.CrossRefPubMed

15.

Momin AA, Steinmetz MP. Evolution of minimally invasive lumbar spine surgery. World Neurosurg. 2020;140:622–6. https://doi.org/10.1016/j.wneu.2020.05.071.CrossRefPubMed

16.

Nimjee SM, Karikari IO, Carolyn AHAB, et al. Safe and accurate placement of thoracic and thoracolumbar percutaneous pedicle screws without image-navigation. Asian J Neurosurg. 2015;10(4):272–5. https://doi.org/10.4103/1793-5482.162700.CrossRefPubMedPubMedCentral

17.

Ojo OA, Owolabi BS, Oseni AW, et al. Surgical site infection in posterior spine surgery. Niger J Clin Pract. 2016;19(6):821–6. https://doi.org/10.4103/1119-3077.183237.CrossRefPubMed

18.

Swann MC, Hoes KS, Aoun SG, et al. Postoperative complications of spine surgery. Best Pract Res Clin Anaesthesiol. 2016;30(1):103–20. https://doi.org/10.1016/j.bpa.2016.01.002.CrossRefPubMed

19.

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. https://doi.org/10.1097/brs.0000000000000960.CrossRef

20.

Wen J, Yang Y, Zhang H, et al. Treatment of grade I and II degree degenerative lumbar spondylolisthesis with minimally invasive surgery-transforaminal lumbar interbody fusion under Quadrant channel. Zhongguo Gu Shang. 2019;32(3):199–206. https://doi.org/10.3969/j.issn.1003-0034.2019.03.002.CrossRefPubMed

21.

Zhang JN, Fan Y, He X, et al. Comparison of robot-assisted and freehand pedicle screw placement for lumbar revision surgery. Int Orthop. 2020. https://doi.org/10.1007/s00264-020-04825-1.CrossRefPubMed

22.

Zhou J, Wang R, Huo X, et al. Incidence of surgical site infection after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2020;45(3):208–16. https://doi.org/10.1097/brs.0000000000003218.CrossRef

Title: A prospective cohort study of the accuracy and safety of robot-assisted minimally invasive spinal surgery
Authors: Mingxing Fan
Yanming Fang
Qi Zhang
Jingwei Zhao
Bo Liu
Wei Tian
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Spondylolisthesis
Spinal Surgery
Minimally Invasive Surgery
Disc Herniation
Published in: BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-022-01503-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A prospective cohort study of the accuracy and safety of robot-assisted minimally invasive spinal surgery

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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