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, Kaleida Health; Buffalo, New York.
Oper Neurosurg (Hagerstown). 2019 Jul 1;17(1):61-69. doi: 10.1093/ons/opy280.
Pedicle screw placement is a commonly performed procedure. Robot-guided screw placement is a recent technological advance that has shown accuracy and reliability with first-generation platforms.
To report our initial experience with the safety, feasibility, and learning curve associated with pedicle screw placement utilizing next-generation robotic guidance.
A retrospective chart review was conducted to obtain data for 20 patients who underwent lumbar pedicle screw placement under robotic guidance after undergoing interbody fusion for lumbar spinal stabilization for degenerative disc disease with or without spondylolisthesis. The newest generation Mazor X (Mazor Robotics Ltd, Caesarea, Israel) was used. Accuracy of screw placement was determined to be grade I to IV. Grade I was in the pedicle (no breach/deviation), grade II was breach < 2 mm, grade III was breach 2 to 4 mm, and grade IV was breach >4 mm; breach direction (superior, lateral, inferior, or medial) was also recorded.
Twenty patients underwent robotically assisted pedicle screw placement of 75 screws at 24 levels. Seventy-four screw placements (98.7%) were grade I; 1 (1.3%) was grade II (medial). No complications occurred. Mean time for screw insertion was 3.6 min. Mean fluoroscopy time was 13.1 s and mean radiation dose was 29.9 mGy.
We found that next-generation robotic spine surgery was safe and feasible with reliable and precise accuracy and a minimal learning curve. As this technology improves, further novel applications are expected to develop. Further research is needed to determine long-term efficacy.
椎弓根螺钉放置是一种常见的操作。机器人引导螺钉放置是最近的一项技术进步，第一代平台已经证明了其准确性和可靠性。
报告我们使用下一代机器人导航系统进行椎弓根螺钉放置的安全性、可行性和学习曲线的初步经验。
回顾性图表审查获取了 20 例患者的数据，这些患者在接受腰椎间融合术以稳定退行性椎间盘疾病伴或不伴脊椎滑脱的腰椎后，在机器人引导下进行了腰椎椎弓根螺钉置入术。使用了最新一代的 Mazor X（Mazor Robotics Ltd，以色列凯撒利亚）。螺钉放置的准确性确定为 I 至 IV 级。I 级是在椎弓根内（无穿透/偏差），II 级是穿透<2mm，III 级是穿透 2 至 4mm，IV 级是穿透>4mm；还记录了穿透方向（上、侧、下或内）。
20 例患者在机器人辅助下进行了 75 枚螺钉、24 个节段的椎弓根螺钉置入术。74 枚螺钉（98.7%）为 I 级；1 枚（1.3%）为 II 级（内侧）。无并发症发生。螺钉插入的平均时间为 3.6 分钟。平均透视时间为 13.1 秒，平均辐射剂量为 29.9 mGy。
我们发现，下一代机器人脊柱手术是安全可行的，具有可靠和精确的准确性，学习曲线较短。随着这项技术的不断改进，预计将开发出更多新的应用。需要进一步的研究来确定长期疗效。
