Khan Asham, Meyers Joshua E, Yavorek Samantha, O'Connor Timothy E, Siasios Ioannis, Mullin Jeffrey P, Pollina John
Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
World Neurosurg. 2019 Mar;123:e474-e481. doi: 10.1016/j.wneu.2018.11.190. Epub 2018 Nov 27.
To study the differences between robot-guided (Mazor X, Mazor Robotics Ltd., Caesarea, Israel) and 3-dimensional (3D) computed tomography (CT) navigation (O-arm Surgical Imaging System, Medtronic, Minneapolis, Minnesota, USA) for the insertion of pedicle screws.
We reviewed the charts of 50 patients who underwent robot-guided pedicle screw insertion (between May 2017-October 2017), and 49 patients who underwent 3D-CT navigation pedicle screw insertion (between September 2015-August 2016). Variables included were age, sex, body mass index, blood loss, length of stay, lumbar level(s), operation time, fluoroscopy time, radiation dose, accuracy, and time-per-screw placement.
Mean ages were 59.3 years in the robotic group and 58.2 years in the 3D-CT navigation group. Mean was 30.7 kg/m in the robotic group and 32.1 kg/m in the 3D-CT navigation group. Mean time-per-screw placement was 3.7 minutes for the robotic group and 6.8 minutes for the 3D-CT navigation group, P < 0.001. In the robotic group, 189 of 190 screws were placed with Ravi grade I accuracy, and 1 was grade II. In the 3D-CT navigation group, 157 of 165 screws were Ravi grade I, and 8 were grade II (P = 0.11). Fluoroscopy time (P < 0.001), time-per-screw placement (P < 0.001), and length of stay (P < 0.001) were significantly lower in the robotic group.
Both technologies are safe and accurate. Robotic technology exposed patients to less fluoroscopy time, decreased time-per-screw placement and shorter hospital stay than 3D-CT navigation. Further studies are warranted to verify our results.
研究机器人引导（以色列凯撒利亚的Mazor Robotics Ltd.公司生产的Mazor X）与三维（3D）计算机断层扫描（CT）导航（美国明尼阿波利斯的美敦力公司生产的O型臂手术成像系统）在椎弓根螺钉置入方面的差异。
我们回顾了50例行机器人引导下椎弓根螺钉置入术患者（2017年5月至2017年10月）以及49例行3D-CT导航下椎弓根螺钉置入术患者（2015年9月至2016年8月）的病历。纳入的变量包括年龄、性别、体重指数、失血量、住院时间、腰椎节段、手术时间、透视时间、辐射剂量、准确性以及每颗螺钉置入时间。
机器人组的平均年龄为59.3岁，3D-CT导航组为58.2岁。机器人组的平均体重指数为30.7kg/m²，3D-CT导航组为32.1kg/m²。机器人组每颗螺钉的平均置入时间为3.7分钟，3D-CT导航组为6.8分钟，P<0.001。在机器人组中，190颗螺钉中有189颗置入精度为拉维一级，1颗为二级。在3D-CT导航组中，165颗螺钉中有157颗为拉维一级，8颗为二级（P=0.11）。机器人组的透视时间（P<0.001）、每颗螺钉置入时间（P<0.001）和住院时间（P<0.001）均显著更低。
两种技术均安全且准确。与3D-CT导航相比，机器人技术使患者接受的透视时间更少，每颗螺钉置入时间缩短，住院时间也更短。有必要进行进一步研究以验证我们的结果。
