Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC.
Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC.
World Neurosurg. 2020 Nov;143:e492-e502. doi: 10.1016/j.wneu.2020.07.203. Epub 2020 Aug 3.
Percutaneous pedicle screws (PPS) are used to stabilize the spine after interbody fusion in minimally invasive approaches. Recently, robotic assistance has been developed to improve the accuracy of PPS. We report our initial experience with ExcelsiusGPS and compare its accuracy with our historical cohort of fluoroscopy-guided PPS.
We reviewed prospectively collected data from our first 100 robot-assisted PPS. We graded accuracy of screws on computed tomography imaging and compared it with a previous cohort of 90 PPS placed using fluoroscopy. We also analyzed the effect of various demographic and perioperative metrics on accuracy.
We placed 103 PPS in the first 20 consecutive patients with postoperative computed tomography imaging using ExcelsiusGPS. All screws were placed at L2 to S1. Our robot-assisted cohort had 6 breaches, with only 2 breaches >2 mm, yielding an overall breach rate of 5.8% and a significant breach rate of 1.9%. In comparison, our fluoroscopy-guided cohort had a breach rate of 3.3% and a significant breach rate of 1.1%, which was not significantly different. More breaches occurred in the first half of cases, suggesting a learning curve with robotic assistance. No demographic or perioperative metrics had a significant effect on accuracy.
Our breach rates with ExcelsiusGPS were low and consistent with others reported in the literature, as well as with other robotic systems. Our series shows equivalent accuracy of placement of PPS with this robotic platform compared with fluoroscopic guidance and suggests a relatively short learning curve.
经皮椎弓根螺钉（PPS）用于微创入路椎间融合后稳定脊柱。最近，开发了机器人辅助以提高 PPS 的准确性。我们报告了使用 ExcelsiusGPS 的初步经验，并将其与我们历史上荧光透视引导的 PPS 队列进行了比较。
我们回顾了我们首批 100 例机器人辅助 PPS 的前瞻性收集数据。我们根据计算机断层扫描成像对螺钉的准确性进行了分级，并与使用荧光透视放置的 90 例 PPS 进行了比较。我们还分析了各种人口统计学和围手术期指标对准确性的影响。
我们在使用 ExcelsiusGPS 的 20 例连续患者中放置了 103 个 PPS，所有螺钉均放置在 L2 至 S1。我们的机器人辅助组有 6 个突破，只有 2 个突破>2mm，总体突破率为 5.8%，显著突破率为 1.9%。相比之下，我们的荧光透视引导组的突破率为 3.3%，显著突破率为 1.1%，差异无统计学意义。更多的突破发生在病例的前半部分，这表明机器人辅助存在学习曲线。没有人口统计学或围手术期指标对准确性有显著影响。
我们使用 ExcelsiusGPS 的突破率较低，与文献报道的其他突破率以及其他机器人系统一致。我们的系列研究表明，与荧光透视引导相比，使用该机器人平台进行 PPS 植入具有相当的准确性，并且表明学习曲线相对较短。
