Lonjon Nicolas, Chan-Seng Emilie, Costalat Vincent, Bonnafoux Benoit, Vassal Matthieu, Boetto Julien
Department of Neurosurgery, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34090, Montpellier, France.
INSERM U1051, Institute for Neurosciences of Montpellier, Pathophysiology and Therapy of Sensory and Motor Deficits, Hôpital Saint Eloi, Montpellier, France.
Eur Spine J. 2016 Mar;25(3):947-55. doi: 10.1007/s00586-015-3758-8. Epub 2015 Jan 10.
While image guidance and neuronavigation have enabled a more accurate placement of pedicle implants, they can inconvenience the surgeon. Robot-assisted placement of pedicle screws appears to overcome these disadvantages. However, recent data concerning the superiority of currently available robots in assisting spinal surgeons are conflicting. The aim of our study was to evaluate the percentage of accurately placed pedicle screws, inserted using a new robotic-guidance system.
20 Patients were operated on successively by the same surgeon using robotic assistance (ROSA™, Medtech) (Rosa group 10 patients, n = 40 screws) or by the freehand conventional technique (Freehand group 10 patients, n = 50 screws). Patient characteristics as well as the duration of the operation and of exposure to X rays were recorded.
The mean age of patients in each group (RG and FHG) was 63 years. Mean BMI and operating time among the RG and FHG were, respectively, 26 and 27 kg/m(2), and 187 and 119 min. Accurate placement of the implant (score A and B of the Gertzbein Robbins classification) was achieved in 97.3% of patients in the RG (n = 36) and in 92% of those in the FHG (n = 50). Four implants in the RG were placed manually following failed robotic assistance.
We report a higher rate of precision with robotic as compared to the FH technique. Providing assistance by permanently monitoring the patient's movements, this image-guided tool helps more accurately pinpoint the pedicle entry point and control the trajectory. Limitations of the study include its small sized and non-randomized sample. Nevertheless, these preliminary results are encouraging for the development of new robotic techniques for spinal surgery.
虽然图像引导和神经导航能够更精确地放置椎弓根植入物，但它们可能会给外科医生带来不便。机器人辅助椎弓根螺钉置入似乎克服了这些缺点。然而，最近有关现有机器人在辅助脊柱外科医生方面优越性的数据相互矛盾。我们研究的目的是评估使用一种新型机器人引导系统插入的椎弓根螺钉准确置入的百分比。
20例患者由同一位外科医生依次进行手术，其中10例患者使用机器人辅助（ROSA™，Medtech）（机器人组，10例患者，40枚螺钉），另外10例患者采用徒手传统技术（徒手组，10例患者，50枚螺钉）。记录患者特征以及手术时间和X线暴露时间。
每组（机器人组和徒手组）患者的平均年龄均为63岁。机器人组和徒手组的平均体重指数和手术时间分别为26和27kg/m²，以及187和119分钟。机器人组97.3%的患者（n = 36）实现了植入物的准确置入（Gertzbein Robbins分类中的A和B级），徒手组为92%（n = 50）。机器人辅助失败后，机器人组有4枚植入物是手动置入的。
我们报告称，与徒手技术相比，机器人技术的精确度更高。通过持续监测患者的动作提供辅助，这种图像引导工具有助于更准确地确定椎弓根入口点并控制轨迹。本研究的局限性包括样本量小且未随机分组。尽管如此，这些初步结果对于脊柱外科新机器人技术的开发具有鼓舞作用。
