Jain Deeptee, Manning Jordan, Lord Elizabeth, Protopsaltis Themistocles, Kim Yong, Buckland Aaron J, Bendo John, Fischer Charla, Goldstein Jeffrey
Division of Spine Surgery, Department of Orthopaedic Surgery, New York University, New York, New York.
Int J Spine Surg. 2019 Oct 31;13(5):459-463. doi: 10.14444/6060. eCollection 2019 Oct.
Robotic-guided navigation systems for pedicle screw placement has gained recent interest to ensure accuracy and safety and diminish radiation exposure. There have been no published studies using a new combined robotics and navigation system (Globus ExcelsiusGPS system). The purpose of this study was to demonstrate safety with this system.
This is a case series of consecutive patients at a single institution from February 1, 2018, to August 31, 2018. All patients who had planned placement of thoracic and lumbar pedicle screws using the combined robotics-navigation system were included. Chart review was performed for operative details. A subgroup analysis was performed on patients with postoperative computed tomography (CT) scans to assess screw placement accuracy using the Gertzbein and Robbins system. Acceptable pedicle screw position was defined as grade A or B.
One hundred six patients were included, with 636 pedicle screws, 6 iliac screws, and 1 S2AI screw. Five cases were aborted for technical issues. In the remaining 101 patients, 88 patients had screws placed using preoperative CT planning and 13 patients using intraoperative fluoroscopy planning. All screws except for 5 pedicle screws in 2 patients were placed successfully using the robot (99%). These 5 pedicle screws were placed by converting to a fluoro-guided technique without robotic assistance. Eighty-six patients had screws placed using a percutaneous technique, and 15 patients had screws placed using an open technique. Ninety-eight patients underwent interbody placement: 28 anterior lumbar interbody fusions (ALIFs), 12 lateral lumbar interbody fusions (LLIFs), and 58 transforaminal lumbar interbody fusions (TLIFs). All ALIFs and LLIFs were performed prior to placement of the screws. Four LIF patients had screws placed in the lateral position. No patients had screw-related complications intraoperatively or postoperatively, and no patients returned to the operating room for screw revision. Thirteen patients underwent postoperative CT for various reasons. Of the 66 pedicle screws that were examined with postoperative CT, all screws (100%) had acceptable position.
This study demonstrates that the combined robotics and navigation system is a novel technology that can be utilized to place pedicle screws and pelvic screws safely and has the potential to reduce screw-related complications.
4 (case series).
用于椎弓根螺钉置入的机器人引导导航系统近来受到关注，以确保准确性和安全性并减少辐射暴露。目前尚无关于一种新型机器人与导航组合系统（Globus ExcelsiusGPS系统）的已发表研究。本研究的目的是证明该系统的安全性。
这是一项对2018年2月1日至2018年8月31日期间单一机构连续患者的病例系列研究。纳入所有计划使用机器人-导航组合系统置入胸腰椎椎弓根螺钉的患者。对手术细节进行病历审查。对术后进行计算机断层扫描（CT）的患者进行亚组分析，使用Gertzbein和Robbins系统评估螺钉置入准确性。可接受的椎弓根螺钉位置定义为A级或B级。
纳入106例患者，共置入636枚椎弓根螺钉、6枚髂骨螺钉和1枚S2AI螺钉。5例因技术问题手术中止。在其余101例患者中，88例患者的螺钉通过术前CT规划置入，13例患者的螺钉通过术中透视规划置入。除2例患者的5枚椎弓根螺钉外，所有螺钉均成功通过机器人置入（99%）。这5枚椎弓根螺钉通过转换为透视引导技术在无机器人辅助的情况下置入。86例患者的螺钉通过经皮技术置入，15例患者的螺钉通过开放技术置入。98例患者接受椎间融合器置入：28例前路腰椎椎间融合术（ALIF）、12例侧路腰椎椎间融合术（LLIF）和58例经椎间孔腰椎椎间融合术（TLIF）。所有ALIF和LLIF均在螺钉置入前进行。4例腰椎椎间融合术患者的螺钉在侧方置入。术中及术后无患者发生螺钉相关并发症，也无患者因螺钉翻修返回手术室。13例患者因各种原因接受术后CT检查。在66枚接受术后CT检查的椎弓根螺钉中，所有螺钉（100%）位置均可接受。
本研究表明，机器人与导航组合系统是一种可用于安全置入椎弓根螺钉和骨盆螺钉的新技术，并且有可能减少螺钉相关并发症。
4（病例系列）。
