Soliman Mohamed A, Khan Asham, O'Connor Timothy E, Foley Kevin, Pollina John
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.
Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA.
Cureus. 2021 Jun 26;13(6):e15939. doi: 10.7759/cureus.15939.
Introduction There has been a surge in robot utilization in spine surgery over the past five years with the rapid development of new spine robotic platforms. This study aimed to compare a new robotic spine platform from Fusion Robotics(Fusion Robotics, Helena, MT) with the widely used Mazor-X Stealth Edition robotic platform (Medtronic, Dublin, Ireland) in terms of workflow and lumbar pedicle screw placement accuracy. Methods A cadaver lab was conducted, which included four procedures with single-level lumbar pedicle screw placement using the Fusion Robotics system. These four procedures were compared to four propensity-score matched cases with single-level lumbar pedicle screw placement using the Mazor-X Stealth Edition. A single surgeon performed all surgeries. The cases were matched in terms of demographics (age, sex, race, BMI) and comorbidities (Charlson Comorbidity Index score). The primary outcome measure was the operative workflow efficiency (duration as measured with a stopwatch by an independent observer). The secondary outcome measures were pedicle screw accuracy and accuracy to plan. Results After propensity-score matching, there were four cases in each group with no significant between-group differences in terms of sex, race, BMI, or surgical levels; however, there were significant differences in terms of age (p=0.01) and comorbidities (p<0.001). The workflow efficiency measurement showed that the Fusion Robotics platform had a significantly shorter duration in terms of the system set-up time, planning to in-position time, and total procedure time (p<0.05). However, there was no significant difference between the robotic platforms in terms of creating a sterile barrier, scanning and importing images, creating a plan, screw placement, screw accuracy, and screw accuracy to plan. Conclusion Based on our findings, the Fusion Robotics platform had a significantly shorter procedure workflow duration while maintaining the same accuracy as the most commonly used robotic platform (Mazor-X). This is the first study to directly compare different spine surgery robotic systems.
引言 随着新型脊柱机器人平台的迅速发展，在过去五年中脊柱手术中机器人的使用激增。本研究旨在比较Fusion Robotics公司（位于蒙大拿州海伦娜市的Fusion Robotics）的新型脊柱机器人平台与广泛使用的Mazor-X Stealth Edition机器人平台（美敦力公司，爱尔兰都柏林）在工作流程和腰椎椎弓根螺钉置入准确性方面的差异。方法 进行了一项尸体实验室研究，其中包括使用Fusion Robotics系统进行的四级单节段腰椎椎弓根螺钉置入手术。将这四级手术与四级倾向评分匹配的使用Mazor-X Stealth Edition进行单节段腰椎椎弓根螺钉置入的病例进行比较。所有手术均由同一位外科医生进行。病例在人口统计学特征（年龄、性别、种族、体重指数）和合并症（Charlson合并症指数评分）方面进行匹配。主要结局指标是手术工作流程效率（由独立观察者用秒表测量的持续时间）。次要结局指标是椎弓根螺钉准确性和与计划的符合度。结果 经过倾向评分匹配后，每组有四个病例，在性别、种族、体重指数或手术节段方面两组之间无显著差异；然而，在年龄（p = 0.01）和合并症（p < 0.001）方面存在显著差异。工作流程效率测量显示，Fusion Robotics平台在系统设置时间、规划到就位时间和总手术时间方面持续时间显著更短（p < 0.05）。然而，在创建无菌屏障、扫描和导入图像、制定计划、螺钉置入、螺钉准确性以及螺钉与计划的符合度方面，机器人平台之间无显著差异。结论 根据我们的研究结果，Fusion Robotics平台的手术工作流程持续时间显著更短，同时保持了与最常用的机器人平台（Mazor-X）相同的准确性。这是第一项直接比较不同脊柱手术机器人系统的研究。
