Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
World Neurosurg. 2019 Jun;126:418-422. doi: 10.1016/j.wneu.2019.03.036. Epub 2019 Mar 12.
Emerging technologies in minimally invasive spinal surgery include surgical robots for navigation and spinal endoscopy. We applied these technologies in concert to treat a critically ill patient with thoracic discitis.
The patient was an 83-year old woman with extensive medical comorbidities. In 2016, she was admitted from her skilled nursing facility with chest pain radiating to her left arm. Following a negative cardiac workup, computed tomography imaging revealed a right paramediastinal thoracic collection with endplate erosion at the T4 and T5 levels. Subsequent magnetic resonance imaging was consistent with spondylodiscitis. We developed a preoperative trajectory with targeting software to the target levels. Following positioning and calibration in the operating room, we used the robot to establish our planned trajectory along the T4-T5 transpedicular route on the left side. We established a working channel and docked the endoscope through the T4-T5 annulus. Frank pus extruded on entering the disc, which we immediately sampled and sent for culture. We next advanced the endoscope into the disc space, allowing us to clean the endplates with microcurettes and copious irrigation. The patient tolerated the procedure well and was sent to the intensive care unit in light of her general medical status. She recovered well and was discharged from our hospital on postoperative day 11 after a course of intravenous antibiotics.
This case represents a novel endoscopic-robotic hybrid spine surgery that we believe will find further applications in spinal surgery.
微创脊柱手术中的新兴技术包括用于导航和脊柱内窥镜的手术机器人。我们将这些技术结合起来治疗一位患有胸椎间盘炎的重症患者。
患者是一位 83 岁的老年女性，患有广泛的合并症。2016 年，她从护理院因胸痛放射至左臂而入院。经过心脏检查阴性后，计算机断层扫描成像显示右侧纵隔胸段有一个集合物，T4 和 T5 水平的终板有侵蚀。随后的磁共振成像与脊椎炎相符。我们用靶向软件制定了术前的目标轨迹。在手术室定位和校准后，我们使用机器人在左侧沿着 T4-T5 经椎弓根的计划轨迹建立。我们建立了一个工作通道，并通过 T4-T5 纤维环对接内窥镜。进入椎间盘时，有脓液涌出，我们立即取样并进行培养。接下来，我们将内窥镜推进椎间盘间隙，使用微型刮刀和大量冲洗来清洁终板。鉴于患者的一般身体状况，她很好地耐受了该手术，并被送入重症监护病房。她恢复良好，在接受静脉抗生素治疗 11 天后出院。
这是一个新的内镜机器人混合脊柱手术案例，我们相信它将在脊柱外科中得到进一步的应用。
