Department of Orthopaedic Surgery, Guy's and St. Thomas' Hospitals, London, UK.
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia.
Clin Spine Surg. 2020 May;33(4):E162-E167. doi: 10.1097/BSD.0000000000000963.
Cadaveric study.
Pedicle screw fixation is an established means of stabilizing the thoracic and lumbar spine. However, there are associated complications including pedicle breach which can result in neurological injury, durotomy, vascular injury, and suboptimal fixation.
The aim of this study is to determine whether use of a navigated robotic platform results in fewer pedicle breaches and the underlying reasons for any difference in pedicle breach rates.
Ten board-certified neuro- and orthopedic spine surgeons inserted 80 percutaneous lumbar screws in 10 unembalmed human cadavers. Forty screws were inserted using conventional fluoroscopic guidance and 40 were inserted using a navigated robotic platform. None of the participating surgeons had any prior experience with navigated robotic spine surgery. At the end of the study each screw was assessed with a computed tomography scan, plain radiographs and visual inspection to determine the presence or absence of pedicle breaches.
Forty percent (40%) of screws inserted using conventional fluoroscopic guidance breached compared with 2.5% of screws inserted with robot assistance (P=0.00005). Lateral breaches accounted for 88.2% (15/17) of all breaches. Detailed analysis revealed that the starting point of screws that breached laterally were significantly more lateral than that of the contralateral accurate screw (P=0.016). Pedicle screw diameter, length, and angulation in the transverse plane did not differ significantly between accurate screws and those that breached (P>0.05).
The use of a navigated robotic platform in the present study resulted in significantly fewer pedicle breaches. This was achieved through correct starting point selection with subsequent safe pedicle screw insertion.
尸体研究。
椎弓根螺钉固定是稳定胸腰椎的一种既定方法。然而，它也存在相关并发症，包括椎弓根破裂，这可能导致神经损伤、硬脊膜切开术、血管损伤和固定效果不佳。
本研究旨在确定使用导航机器人平台是否会减少椎弓根破裂，并确定椎弓根破裂率差异的根本原因。
10 名具有神经和骨科脊柱手术认证的外科医生在 10 具未经防腐处理的人体尸体上共置入 80 枚经皮腰椎螺钉。其中 40 枚螺钉使用传统的透视引导置入，40 枚螺钉使用导航机器人平台置入。参与研究的外科医生均无导航机器人脊柱手术经验。研究结束时，对每个螺钉进行 CT 扫描、普通 X 线片和肉眼检查，以确定是否存在椎弓根破裂。
使用传统透视引导置入的螺钉中，有 40%（40 枚）发生破裂，而使用机器人辅助置入的螺钉中，有 2.5%（1 枚）发生破裂（P=0.00005）。横向破裂占所有破裂的 88.2%（15/17）。详细分析显示，发生横向破裂的螺钉起始点明显比对侧准确螺钉更偏外侧（P=0.016）。准确螺钉和破裂螺钉的横断面上螺钉直径、长度和角度差异无统计学意义（P>0.05）。
本研究中使用导航机器人平台可显著减少椎弓根破裂。这是通过正确选择起始点并随后安全置入椎弓根螺钉来实现的。
