Department of Orthopaedics, Center of Sports Medicine and Orthopaedics, Chattanooga, TN, USA.
Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA.
Spine Deform. 2022 Jan;10(1):5-17. doi: 10.1007/s43390-021-00403-6. Epub 2021 Sep 6.
STUDY DESIGN/METHODS: Review article.
The goal of this article is to review the available evidence for computerized navigation and robotics as an accuracy improvement tool for spinal deformity surgery, as well as to consider potential complications, impact on clinical outcomes, radiation exposure, and costs. Pedicle screw and rod construct are widely utilized for posterior spinal fixation in spinal deformity correction. Freehand placement of pedicle screws has long been utilized, although there is variable potential for inaccuracy depending on surgeon skill and experience. Malpositioned pedicle screws may have significant clinical implications ranging from nerve root irritation, inadequate fixation, CSF leak, perforation of the great vessels, or spinal cord damage. Computer-based navigation and robotics systems were developed to improve pedicle screw insertion accuracy and consistency, and decrease the risk of malpositioned pedicle fixation. The available evidence suggests that computer-based navigation and robotic-assisted guidance systems for pedicle cannulation are at least equivalent, and in several reports superior, to freehand techniques in terms of accuracy. CT and robotic navigation systems do appear to decrease radiation exposure to the operative team in some reports. Published reports do indicate longer operative times with use of robotic navigation compared with traditional freehand techniques for pedicle screw placement. To date, there is no conclusive evidence that use of CT or robotic navigation has any measurable impact on patient outcomes or overall complication reduction. There are theoretical advantages with robotic and CT navigation in terms of both speed and accuracy for severe spinal deformity or complex revision cases, however, there is a need for studies to investigate this technology in these specific cases. There is no evidence to date demonstrating the cost effectiveness of CT or robotic navigation as compared with traditional pedicle cannulation techniques.
The review of available evidence suggests that computer-based navigation and robotic-assisted guidance systems for pedicle cannulation are at least equivalent, and in several reports superior, to freehand techniques in terms of radiographic accuracy. There is no current clinical evidence that the use of navigation or robotic techniques leads to improved patient outcomes or decreased overall complications or reoperation rates, and the use of these systems may substantially increase surgical costs.
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研究设计/方法：综述文章。
本文旨在回顾计算机导航和机器人技术作为脊柱畸形手术准确性提高工具的现有证据，并考虑潜在并发症、对临床结果的影响、辐射暴露和成本。在脊柱畸形矫正中，椎弓根螺钉和棒结构广泛用于脊柱后路固定。徒手放置椎弓根螺钉已有很长时间的应用，尽管由于外科医生的技能和经验不同，存在一定的不准确的可能性。椎弓根螺钉位置不当可能会产生重大的临床影响，包括神经根刺激、固定不充分、CSF 漏、大血管穿孔或脊髓损伤。基于计算机的导航和机器人系统的开发是为了提高椎弓根螺钉插入的准确性和一致性，并降低椎弓根固定位置不当的风险。现有证据表明，基于计算机的导航和机器人辅助导向系统用于椎弓根穿刺在准确性方面至少与徒手技术相当，在一些报道中甚至优于徒手技术。在一些报道中，CT 和机器人导航系统确实似乎降低了手术团队的辐射暴露。与传统的徒手技术相比，使用机器人导航进行椎弓根螺钉放置的手术时间明显延长。迄今为止，没有确凿的证据表明使用 CT 或机器人导航对患者的结果或整体并发症的减少有任何可衡量的影响。在严重脊柱畸形或复杂翻修病例中，机器人和 CT 导航在速度和准确性方面具有理论优势，然而，需要研究来调查这项技术在这些特定病例中的应用。迄今为止，没有证据表明 CT 或机器人导航在成本效益方面优于传统的椎弓根穿刺技术。
对现有证据的回顾表明，基于计算机的导航和机器人辅助导向系统用于椎弓根穿刺在影像学准确性方面至少与徒手技术相当，在一些报道中甚至优于徒手技术。目前没有临床证据表明导航或机器人技术的使用会导致患者结果的改善或总体并发症或再次手术率的降低，并且这些系统的使用可能会大大增加手术成本。
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