Meyers Joshua E, Khan Asham, Pollina John
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York.
Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, New York.
Oper Neurosurg. 2019 Jun 1;16(6):766-767. doi: 10.1093/ons/opy246.
Recent years have shown an increase in implementing robotics in surgical procedures. Utilizing robotic technology in spine surgery remains limited in comparison to other surgical fields. We present a surgical video of minimally invasive robotic-assisted insertion of posterior pedicle screws using the newest generation robotic technology (Mazor X, Mazor Robotics Ltd, Caesarea, Israel), in a 29-yr-old man who suffers from Grade I degenerative spondylolisthesis at L5-S1 levels and severe, right-sided foraminal stenosis. The plan was to perform anterior fusion at L5-S1 using robotic guidance with posterior pedicle screw supplementation due to his extensive smoking history. This technology has two distinct registration methods: (1) using a preoperative thin-cut computed tomography (CT) scan to create a surgical plan for screw placement; and (2) scan-and-plan using intraoperative 3-dimensional (3D) imaging to create a plan in real-time intraoperatively. We present the scan-and-plan technique. The widely used freehand technique allows the surgeon to manually direct tools and implants relying on the 6-degrees-of-freedom of the human arm. When Mazor X robotic technology is utilized, a pilot hole is drilled through a cannula docked to the bone above the entry point, which provides the surgeon with a planned trajectory and eliminates 4 of 6-degrees-of-freedom (up/down and yaw remain). This provides increased multidimensional control and reduces reliance on hand-eye coordination with simultaneous concentration on the imaging, potentially leading to increased rates of accuracy and reduction in severe complications of misplaced screws. Further prospective clinical studies are needed to determine the long-term effectiveness of this technology. Patient consent was obtained prior to performing the procedure. Institutional board review approval is not required for the report of a single case at the University at Buffalo.
近年来，手术中机器人技术的应用有所增加。与其他外科领域相比，机器人技术在脊柱手术中的应用仍然有限。我们展示了一段手术视频，内容是一名29岁男性患者，患有L5 - S1节段I度退行性椎体滑脱和严重的右侧椎间孔狭窄，使用最新一代机器人技术（Mazor X，Mazor Robotics Ltd，以色列凯撒利亚）进行微创机器人辅助后路椎弓根螺钉植入。由于他有长期吸烟史，计划在L5 - S1节段进行前路融合，并在机器人引导下辅助后路椎弓根螺钉固定。这项技术有两种不同的注册方法：（1）使用术前薄层计算机断层扫描（CT）来制定螺钉置入的手术计划；（2）术中使用三维（3D）成像进行扫描并制定计划，以便在术中实时创建计划。我们展示的是扫描并制定计划技术。广泛使用的徒手技术允许外科医生依靠手臂的六自由度手动操作工具和植入物。当使用Mazor X机器人技术时，通过与进针点上方骨骼对接的套管钻一个导孔，这为外科医生提供了一条规划好的轨迹，并消除了六自由度中的四个（上下和偏航自由度保留）。这提供了更高的多维控制，减少了对手眼协调的依赖，同时专注于成像，可能会提高准确率并降低螺钉误置的严重并发症发生率。需要进一步的前瞻性临床研究来确定这项技术的长期有效性。在进行手术前已获得患者同意。布法罗大学报告单个病例不需要机构审查委员会的批准。
