Godzik Jakub, Walker Corey T, Theodore Nicholas, Uribe Juan S, Chang Steven W, Snyder Laura A
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Department of Neurosurgery, John Hopkins University, Baltimore, Maryland.
Oper Neurosurg (Hagerstown). 2019 Mar 1;16(3):E86-E87. doi: 10.1093/ons/opy288.
Minimally invasive surgery (MIS) techniques may enable faster patient recovery and reduce the incidence of postoperative infections. Image-guided approaches to spinal instrumentation and interbody fusion have gained popularity in MIS, reducing radiation exposure and improving screw placement accuracy. Use of a novel computed tomography (CT) navigation-based robotic arm provides for live image-guided surgery, with the potential for augmenting existing MIS approaches and improving the accuracy of instrumentation placement. We report on the surgical technique of MIS transforaminal lumbar interbody fusion (TLIF) performed with the assistance of a new robotic device (ExcelsiusGPS, Globus Medical Inc, Audubon, Pennsylvania) and intraoperative CT guidance in a patient with single-level lumbar spondylolisthesis. The patient gave written informed consent before treatment. Institutional review board approval was deemed unnecessary. The patient was positioned prone on the operating room table, and an intraoperative CT was obtained with stereotactic arrays placed bilaterally in the posterior superior iliac spine. Screw trajectories were planned using the ExcelsiusGPS software and placed percutaneously with the robotic arm without using a Kirschner wire. Interbody placement was performed via an expandable retractor after muscle dilation. Screw placement accuracy was determined with postoperative CT, which demonstrated good screw positioning without breach. The patient recovered well and was discharged home without complications. The combined use of the new robotic device and intraoperative CT enables accurate and safe fixation for the treatment of symptomatic lumbar spondylolisthesis. The operative video demonstrates the technical nuances of positioning, stereotactic marker placement, work flow, and screw placement. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
微创手术(MIS)技术可能使患者恢复更快,并降低术后感染的发生率。图像引导下的脊柱内固定和椎间融合方法在微创手术中越来越受欢迎,减少了辐射暴露并提高了螺钉置入的准确性。使用一种新型的基于计算机断层扫描(CT)导航的机器人手臂可实现实时图像引导手术,有可能增强现有的微创手术方法并提高器械置入的准确性。我们报告了在一名单节段腰椎滑脱患者中,借助一种新型机器人设备(ExcelsiusGPS,Globus Medical Inc,宾夕法尼亚州奥杜邦)和术中CT引导进行的微创经椎间孔腰椎椎间融合术(TLIF)的手术技术。患者在治疗前签署了书面知情同意书。机构审查委员会批准被认为不必要。患者俯卧于手术台上,通过双侧置于后上棘的立体定向阵列进行术中CT扫描。使用ExcelsiusGPS软件规划螺钉轨迹,并通过机器人手臂经皮置入螺钉,无需使用克氏针。在肌肉扩张后,通过可扩张牵开器进行椎间融合器置入。术后CT确定螺钉置入的准确性,结果显示螺钉位置良好,无突破。患者恢复良好,无并发症出院。新型机器人设备与术中CT的联合使用能够准确、安全地固定,用于治疗有症状的腰椎滑脱。手术视频展示了定位、立体定向标记放置、工作流程和螺钉置入的技术细节。经亚利桑那州凤凰城巴罗神经学研究所许可使用。
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