Division of Spine, Department of Neurosurgery, Duke University Medical Center, 200 Trent Drive, Durham, NC, 27710, USA.
Acta Neurochir (Wien). 2021 Nov;163(11):2983-2990. doi: 10.1007/s00701-021-04894-0. Epub 2021 Jun 15.
Robotic-assisted surgery is becoming more widely applied in surgical subspecialties due to its intraoperative and postoperative advantages such as minimally invasive approach, reduced blood loss, shorter hospital stay, and decreased incidence of postoperative complications. However, robotic devices were only recently introduced in the field of spinal surgery. Specifically, percutaneous approaches involving computer-assisted image guidance are relatively new in iliac screw fixation. Previous methods focused on the use of S2-alar-iliac (S2AI) screw fixation which allows for pelvic fixation without a need for side connectors. However, for patients with destructive lesions of the sacrum, placement of these S2AI screws may not be feasible. The purpose of this technical note is to illustrate the implementation of robotic-assisted percutaneous iliac screw fixation in two cases which allows for minimally invasive attachment to the proximal lumbar screws without a side connector and eliminates a potential source of instrumentation failure.
Robotic-assisted percutaneous iliac screw fixation was performed on two patients. The robotics system was used to merge the fluoroscopic images with intraoperative computed tomography (CT) images to plan the trajectories for placement of bilateral pedicle and iliac screws. Intraoperative CT scan was again performed to confirm proper placement of all screws. Rods were then engaged bilaterally with the pedicle and iliac screws without the use of side connectors.
The patients did not experience immediate postoperative complications and had stable hardware at one-month follow-up. Our cases demonstrate the surgical efficiency of robotic-assisted lumbo-iliac instrumentation which obviates the need to use a side connector, which is commonly used in iliac fixation. This eliminates a step, which can reduce the possibility of instrumentation failure.
Robotic-assisted percutaneous iliac screw fixation is a safe and feasible technique to improve operative and clinical outcomes in complex spinal instrumentation surgeries.
由于机器人辅助手术具有术中及术后优势，如微创入路、减少失血、缩短住院时间和降低术后并发症发生率，因此在外科亚专业领域的应用越来越广泛。然而，机器人设备最近才被引入脊柱外科领域。具体来说，计算机辅助图像引导的经皮入路在髂螺钉固定中相对较新。以前的方法主要集中在使用 S2-臀（S2AI）螺钉固定，这种固定方法允许骨盆固定而无需侧连接器。然而，对于骶骨破坏性病变的患者，这些 S2AI 螺钉的放置可能不可行。本技术说明的目的是说明在两个病例中实施机器人辅助经皮髂螺钉固定的情况，该方法允许通过微创方式连接到近端腰椎螺钉，而无需侧连接器，并消除了仪器故障的潜在来源。
对两名患者进行了机器人辅助经皮髂螺钉固定。机器人系统用于将荧光透视图像与术中计算机断层扫描（CT）图像融合，以规划双侧椎弓根和髂螺钉的放置轨迹。再次进行术中 CT 扫描以确认所有螺钉的正确位置。然后，在不使用侧连接器的情况下，双侧用椎弓根和髂螺钉连接棒。
患者术后即刻未发生并发症，在一个月的随访时，内固定物稳定。我们的病例表明，机器人辅助腰骶仪器固定具有手术效率，可以避免使用侧连接器，这在髂骨固定中很常见。这消除了一个步骤，从而降低了仪器故障的可能性。
机器人辅助经皮髂螺钉固定是一种安全可行的技术，可以提高复杂脊柱器械手术的手术和临床效果。
