Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Presbyterian Hospital Plano, Plano, TX 75093, USA.
Eur Spine J. 2013 Mar;22(3):661-6. doi: 10.1007/s00586-012-2499-1. Epub 2012 Sep 14.
Surgeons' interest in image and/or robotic guidance for spinal implant placement is increasing. This technology is continually improving and may be particularly useful in patients with challenging anatomy. Only through careful clinical evaluation can its successful applications, limitations, and areas for improvement be defined. This study evaluates the outcomes of robotic-assisted screw placement in a consecutive series of 102 patients.
Data were recorded from technical notes and operative records created immediately following each surgery case, in which the robotic system was used to guide pedicle screw placement. All cases were performed at the same hospital by a single surgeon. The majority of patients had spinal deformity and/or previous spine surgery. Each planned screw placement was classified as: (1) successful/accurately placed screw using robotic guidance; (2) screw malpositioned using robot; (3) use of robot aborted and screw placed manually; (4) planned screw not placed as screw deemed non essential for construct stability. Data from each case were reviewed by two independent researchers to indentify the diagnosis, number of attempted robotic guided screw placements and the outcome of the attempted placement as well as complications or reasons for non-placement.
Robotic-guided screw placement was successfully used in 95 out of 102 patients. In those 95 patients, 949 screws (87.5 % of 1,085 planned screws) were successfully implanted. Eleven screws (1.0 %) placed using the robotic system were misplaced (all presumably due to "skiving" of the drill bit or trocar off the side of the facet). Robotic guidance was aborted and 110 screws (10.1 %) were manually placed, generally due to poor registration and/or technical trajectory issues. Fifteen screws (1.4 %) were not placed after intraoperative determination that the screw was not essential for construct stability. The robot was not used as planned in seven patients, one due to severe deformity, one due to very high body mass index, one due to extremely poor bone quality, one due to registration difficulty caused by previously placed loosened hardware, one due to difficulty with platform mounting and two due to device technical issues.
Of the 960 screws that were implanted using the robot, 949 (98.9 %) were successfully and accurately implanted and 11 (1.1 %) were malpositioned, despite the fact that the majority of patients had significant spinal deformities and/or previous spine surgeries. "Tool skiving" was thought to be the inciting issue with the misplaced screws. Intraoperative anteroposterior and oblique fluoroscopic imaging for registration is critical and was the limiting issue in four of the seven aborted cases.
外科医生对脊柱植入物放置的图像和/或机器人引导越来越感兴趣。这项技术在不断改进，对于具有挑战性的解剖结构的患者可能特别有用。只有通过仔细的临床评估，才能确定其成功应用、局限性和改进领域。本研究评估了连续 102 例患者中机器人辅助螺钉放置的结果。
从立即在每个手术病例后创建的技术记录和手术记录中记录数据，其中机器人系统用于指导椎弓根螺钉放置。所有病例均由同一位外科医生在同一家医院进行。大多数患者有脊柱畸形和/或以前的脊柱手术。每个计划的螺钉放置被分类为：(1) 使用机器人引导准确放置的螺钉；(2) 机器人放置的螺钉位置不当；(3) 机器人中止并手动放置螺钉；(4) 计划放置的螺钉未放置，因为螺钉被认为对结构稳定性不重要。两名独立研究人员审查了每个病例的数据，以确定诊断、尝试使用机器人引导螺钉放置的数量以及尝试放置的结果以及并发症或未放置的原因。
在 102 名患者中有 95 名成功使用机器人引导螺钉放置。在这 95 名患者中，成功植入了 949 枚螺钉（计划植入的 1085 枚螺钉中的 87.5%）。11 枚（1.0%）使用机器人系统放置的螺钉位置不当（所有螺钉都可能因钻头或套管从关节突外侧“滑行”而导致）。机器人引导被中止，110 枚螺钉（10.1%）手动放置，通常是由于注册和/或技术轨迹问题。在术中确定螺钉对结构稳定性不重要后，有 15 枚螺钉（1.4%）未放置。机器人未按计划使用在 7 名患者中，1 名患者因严重畸形，1 名患者因体重指数极高，1 名患者因骨质量极差，1 名患者因先前放置的松动硬件导致注册困难，1 名患者因平台安装困难，2 名患者因设备技术问题。
在使用机器人植入的 960 枚螺钉中，949 枚（98.9%）成功且准确植入，11 枚（1.1%）位置不当，尽管大多数患者有明显的脊柱畸形和/或以前的脊柱手术。“工具滑行”被认为是螺钉位置不当的原因。用于注册的术中前后和斜位透视成像至关重要，在中止的 7 个病例中的 4 个中是限制因素。
