Lee Nathan J, Khan Asham, Lombardi Joseph M, Boddapati Venkat, Park Paul J, Mathew Justin, Leung Eric, Mullin Jeffrey P, Pollina John, Lehman Ronald A
Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA.
Department of Neurosurgery, State University of New York, Buffalo, NY, USA.
J Spine Surg. 2021 Sep;7(3):326-334. doi: 10.21037/jss-21-14.
Current literature on robot-assisted S2 alar-iliac (S2AI) screw placement shows favorable outcomes and screw accuracy; however, the data is limited by a few retrospective, single-surgeon studies. To the author's knowledge, this is the first multicenter study which evaluates the accuracy of robot-assisted S2AI screws.
Adult (≥18 years old) patients who underwent robot-assisted S2AI screw placement from 2017-2019 were reviewed. All surgeries used the same proprietary robotic guidance system, Mazor X (Mazor Robotics Ltd).
A total of 65 screws were assessed in 31 patients. The mean follow-up ± standard deviation was 362±190 days (minimum was 90 days). The mean age was 61.1±11 years old, and 54.8% (n=17) of patients were female. Nearly half of the patients had a primary diagnosis of degenerative scoliosis (48.4%, n=15). Other diagnosis included pseudarthrosis (22.6%, n=7), degenerative disc disease (16.1%, n=5), and high-grade spondylolisthesis (12.9%, n=4). The mean length and diameter of screws were 84.6±6.1 mm and 8.4±0.7, respectively. The mean axial and sagittal angles were 50.0±6.3 and 24.0±10.5, respectively. The overall screw accuracy was 93.8% (n=61). There were four iliac cortex breaches (anterior =3, inferior 1) with a mean breach distance of 3.5±3.2. No statistically significant differences in screw length, diameter, axial angle, and sagittal angle were observed between screws with and without a breach. No intraoperative neurologic, vascular, or visceral complications from the S2AI screw were observed. No post-discharge wound complications, screw prominence issues, or revision of S2AI screws were observed during the study's follow-up period.
Robot-assisted S2AI screw placement was found to be safe and accurate in this multicenter study. This is largely attributed to the versatility of the robotic guidance software that allows for detailed and precise preoperative and intraoperative planning.
目前关于机器人辅助骶2翼髂螺钉（S2AI）置入的文献显示出良好的效果和螺钉准确性；然而，数据受到一些回顾性、单术者研究的限制。据作者所知，这是第一项评估机器人辅助S2AI螺钉准确性的多中心研究。
回顾了2017年至2019年接受机器人辅助S2AI螺钉置入的成年（≥18岁）患者。所有手术均使用相同的专有机器人引导系统，Mazor X（Mazor Robotics Ltd）。
共评估了31例患者的65枚螺钉。平均随访时间±标准差为362±190天（最短为90天）。平均年龄为61.1±11岁，54.8%（n = 17）的患者为女性。近一半患者的主要诊断为退变性脊柱侧凸（48.4%，n = 15）。其他诊断包括假关节（22.6%，n = 7）、退变性椎间盘疾病（16.1%，n = 5）和重度腰椎滑脱（12.9%，n = 4）。螺钉的平均长度和直径分别为84.6±6.1 mm和8.4±0.7。平均轴向角和矢状角分别为50.0±6.3和24.0±10.5。总体螺钉准确性为93.8%（n = 61）。有4例髂骨皮质穿孔（前方3例，下方1例），平均穿孔距离为3.5±3.2。在有穿孔和无穿孔的螺钉之间，未观察到螺钉长度、直径、轴向角和矢状角有统计学显著差异。未观察到S2AI螺钉术中神经、血管或内脏并发症。在研究随访期间，未观察到出院后伤口并发症、螺钉突出问题或S2AI螺钉翻修情况。
在这项多中心研究中，发现机器人辅助S2AI螺钉置入是安全且准确的。这在很大程度上归因于机器人引导软件的多功能性，其允许进行详细而精确的术前和术中规划。
