Department of Spine Surgery, Peking University Fourth School of Clinical Medicine and Beijing Jishuitan Hospital, Beijing, China.
Department of Spine Surgery, Peking University Fourth School of Clinical Medicine and Beijing Jishuitan Hospital, Beijing, China.
World Neurosurg. 2019 May;125:e429-e434. doi: 10.1016/j.wneu.2019.01.097. Epub 2019 Jan 29.
To compare the clinical accuracy and perioperative outcomes for pedicle screw placement in transforaminal lumbar interbody fusion (TLIF) between the robot-assisted (RA) technique and fluoroscopy-guided (FG) technique.
Seventy-seven patients scheduled to undergo RA (n = 43) and FG (n = 44) TLIF surgery were included. Patient demographics, radiographic accuracy, and perioperative outcomes were recorded and compared. The accuracy of pedicle screw placement was according to the Gertzbein and Robbins scale and facet joint violation. Perioperative outcomes mainly included operative time, radiation exposure, and revisions.
Of the 176 screws in the RA group, 164 screws were grade A, and 9, 2, and 1 screws were grades B, C, and D, respectively. Of the 204 screws in the FG group, 175 screws were grade A, with 16 screws scored as grade B, 8 screws scored as grade C, 3 screws scored as grade D, and 2 screws scored as grade E. The rate of perfect screw position (grade A) was higher in the RA group than in the FG group (93.2% vs. 85.8%, respectively; P = 0.020). In the FG group, 191 screws (93.6%) were clinically acceptable (groups A and B), whereas more acceptable screw positions were achieved in the RA group (98.3%; P = 0.024). Fewer screws in the RA group violated the proximal facet joint (5 vs. 24 screws, respectively; P = 0.001). The radiation dose was lower in the RA group (25.9 ± 14.2 vs. 70.5 ± 27.3 μSv, respectively; P < 0.001). Two screws in the FG group required a revision, but no revision was required in the RA group.
RA pedicle screw placement is an accurate and safe procedure in TLIF for lumbar degenerative disease.
比较经椎间孔腰椎体间融合术（TLIF）中机器人辅助（RA）技术和透视引导（FG）技术椎弓根螺钉置钉的临床准确性和围手术期结果。
纳入 77 例拟行 RA（n=43）和 FG（n=44）TLIF 手术的患者。记录并比较患者的人口统计学资料、放射学准确性和围手术期结果。椎弓根螺钉放置的准确性根据 Gertzbein 和 Robbins 分级和关节突关节侵犯进行评估。围手术期结果主要包括手术时间、辐射暴露和翻修。
RA 组的 176 枚螺钉中，164 枚螺钉为 A 级，9、2 和 1 枚螺钉分别为 B、C 和 D 级。FG 组的 204 枚螺钉中，175 枚螺钉为 A 级，16 枚螺钉为 B 级，8 枚螺钉为 C 级，3 枚螺钉为 D 级，2 枚螺钉为 E 级。RA 组螺钉位置完美（A级）的比例高于 FG 组（93.2%比 85.8%；P=0.020）。FG 组 191 枚（93.6%）螺钉临床可接受（A 组和 B 组），而 RA 组螺钉位置更可接受（98.3%；P=0.024）。RA 组侵犯近侧关节突的螺钉更少（5 枚比 24 枚；P=0.001）。RA 组的辐射剂量较低（25.9±14.2 比 70.5±27.3 μSv；P<0.001）。FG 组有 2 枚螺钉需要翻修，而 RA 组则不需要。
RA 椎弓根螺钉置入在腰椎退行性疾病的 TLIF 中是一种准确、安全的方法。
