Pham Martin H, Shah Vrajesh J, Diaz-Aguilar Luis Daniel, Osorio Joseph A, Lehman Ronald A
Department of Neurosurgery, UC San Diego Health, University of California San Diego School of Medicine, 9300 Campus Point Drive, MC7893, La Jolla, San Diego, CA, 92037, USA.
Department of Orthopedic Surgery, The Daniel and Jane Och Spine Hospital at NewYork-Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Eur Spine J. 2022 Jan;31(1):95-103. doi: 10.1007/s00586-021-06980-4. Epub 2021 Oct 1.
Multiple-rod constructs (MRCs) are often used in deformity correction for increased stability and rigidity. There are currently no reports showing minimally invasive placement of MRCs in adult deformity surgery and its technical feasibility through preoperative software planning.
Data were collected retrospectively from medical records of six consecutive patients who underwent minimally invasive MRCs with robotics planning by a single surgeon at an academic center between March-August 2020.
A total of six patients (4 females, mean age 69.7 years) underwent minimally invasive long-segment (6 +) posterior fixation with multiple rods (3 +) using the Mazor X Stealth Edition robotics platform. Average follow-up was 14.3 months. All patients underwent oblique lumbar interbody fusion (OLIF) as a first stage, followed by second stage posterior fixation in the same day. The mean number of levels posteriorly instrumented was 8.8. One patient underwent 3 rod fixation (1 iliac, 2 S2AI) and 5 patients underwent quad rod fixation (2 iliac, 2 S2AI). The mean time to secure all rods was 8 min 36 s. Mean improvement in spinopelvic parameters was -4.9 cm sagittal vertical axis, 18.0° lumbar lordosis, and -10.7° pelvic tilt with an average pelvic incidence of 62.5°. Estimated blood loss (EBL) was 100-250 cc with no blood transfusions, and all but one patient ambulated on postoperative day 1 or 2.
Spinal robotics brings us into a new era of minimally invasive construct design. To our knowledge, this is the first description of the technical feasibility of MRCs in minimally invasive adult spinal deformity surgery.
多棒结构（MRCs）常用于畸形矫正，以提高稳定性和刚性。目前尚无报告显示MRCs在成人畸形手术中的微创置入及其通过术前软件规划的技术可行性。
回顾性收集2020年3月至8月在某学术中心由一名外科医生采用机器人辅助规划进行微创MRCs手术的6例连续患者的病历资料。
共有6例患者（4例女性，平均年龄69.7岁）使用Mazor X Stealth Edition机器人平台接受了多棒（3根及以上）微创长节段（6节及以上）后路固定。平均随访时间为14.3个月。所有患者均先行斜外侧腰椎椎间融合术（OLIF）作为第一阶段，然后在同一天进行第二阶段后路固定。后路固定的平均节段数为8.8个。1例患者采用3根棒固定（1根髂骨棒，2根S2AI棒），5例患者采用4根棒固定（2根髂骨棒，2根S2AI棒）。固定所有棒的平均时间为8分36秒。矢状垂直轴平均改善-4.9 cm，腰椎前凸平均改善18.0°，骨盆倾斜平均改善-10.7°，平均骨盆入射角为62.5°。估计失血量（EBL）为100 - 250 cc，无输血情况，除1例患者外，所有患者均在术后第1天或第2天即可行走。
脊柱机器人技术使我们进入了微创结构设计的新时代。据我们所知，这是首次描述MRCs在成人脊柱畸形微创手术中的技术可行性。
