Pechlivanis Ioannis, Kiriyanthan George, Engelhardt Martin, Scholz Martin, Lücke Sebastian, Harders Albrecht, Schmieder Kirsten
Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
Spine (Phila Pa 1976). 2009 Feb 15;34(4):392-8. doi: 10.1097/BRS.0b013e318191ed32.
A prospective analysis.
The idea of this study was to evaluate a new miniature robotic system providing passive guidance for pedicle screw placement at the lumbar spine. Special focus was laid on the postoperative accuracy of screw placement.
Recent technical developments lead to a minimization of pedicle screw fixation techniques. However, the use of navigational techniques is still under controversy.
Patients selected for a minimal invasive posterior lumbar interbody fusion received a spiral computer tomographic scan before surgery. The miniature hexapod robot was mounted to the spinous process and the system moves to the exact entry point according to the trajectory of the surgeon's preoperative plan. After minimal invasive screw placement all patients received routinely a postoperative spiral computer tomographic scan. Screws placed exactly within the pedicle were evaluated as group A, screws deviating <2 mm were evaluated as group B, > or =2 mm to <4 mm (group C); > or =4 mm to <6 mm (group D); and more than 6 mm (group E).
Thirty-one patients received a PLIF with percutaneous posterior pedicle screw insertion using the bone mounted miniature robotic device. A total of 133 pedicle screws were placed. The majority of the screws were placed in L5 (58 screws; 43.6%). In axial plane, 91.7% of the screws were evaluated as group A and 6.8% were evaluated as group B. In longitudinal plane, 81.2% of the screws were evaluated as group A and 9.8% were evaluated as group B. In 1 screw (L5 right) the postoperative evaluation was done as group C (axial plane) and D (longitudinal plane). In 29/31 cases the integration of the miniature robotic system was successful.
In our study the first clinical assessment of a new bone mounted robot system guiding percutaneous pedicle screw placement was done. A deviation <2 mm to the surgeon 's plan in 91.0% to 98.5% verifies the system's accuracy.
前瞻性分析。
本研究旨在评估一种新型微型机器人系统，该系统为腰椎椎弓根螺钉置入提供被动引导。特别关注螺钉置入的术后准确性。
近期技术发展使椎弓根螺钉固定技术得以最小化。然而，导航技术的使用仍存在争议。
入选接受微创后路腰椎椎间融合术的患者在术前接受螺旋计算机断层扫描。微型六足机器人安装在棘突上，系统根据外科医生术前计划的轨迹移动到精确的进针点。在微创螺钉置入后，所有患者常规接受术后螺旋计算机断层扫描。将精确置入椎弓根内的螺钉评估为A组，偏差<2mm的螺钉评估为B组，≥2mm至<4mm（C组）；≥4mm至<6mm（D组）；以及超过6mm（E组）。
31例患者接受了使用骨固定微型机器人装置的经皮后路椎弓根螺钉置入的PLIF手术。共置入133枚椎弓根螺钉。大多数螺钉置入L5（58枚；43.6%）。在轴平面上，91.7%的螺钉评估为A组，6.8%评估为B组。在纵平面上，81.2%的螺钉评估为A组，9.8%评估为B组。1枚螺钉（L5右侧）术后评估为C组（轴平面）和D组（纵平面）。在29/31例病例中，微型机器人系统的整合成功。
在我们的研究中，首次对一种引导经皮椎弓根螺钉置入的新型骨固定机器人系统进行了临床评估。与外科医生计划的偏差<2mm的比例为91.0%至98.5%，证实了该系统的准确性。
