Department of Orthopedics, Hebei General Hospital, No. 348 Hepingxi Road, Shijiazhuang, Hebei, China.
Pain Res Manag. 2021 Dec 20;2021:6894001. doi: 10.1155/2021/6894001. eCollection 2021.
Robot-assisted pedicle screw placement is usually performed under general anesthesia to keep the body still. The aim of this study was to compare the accuracy of the robot-assisted technique under regional anesthesia with that of conventional fluoroscopy-guided percutaneous pedicle screw placement under general anesthesia in minimally invasive lumbar fusion surgery.
This study recruited patients who underwent robot-assisted percutaneous endoscopic lumbar interbody fusion (PELIF) or fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) between December 2017 and February 2020 at a single center. Based on the method of percutaneous pedicle screw placement used, patients were divided into the robot-assisted under regional anesthesia (group RE-RO) and fluoroscopy-guided under general anesthesia (group GE-FLU) groups. The primary outcome measures were screw accuracy and the incidence of facet joint violation (FJV). Secondary outcome measures included X-ray and visual analogue scale (VAS) scores which were used to evaluate the degree of the postoperative pain at 4 hours and on postoperative days 1, 2, and 3. Intraoperative adverse events were also recorded.
Eighteen patients were included in group RE-RO, and 23 patients were included in group GE-FLU. The percentages of clinically acceptable screws (Gertzbein and Robbins grades A and B) were 94.4% and 91.5%, respectively. There was no significant difference in the percentages of clinically acceptable screws (=0.44) or overall Gertzbein and Robbins screw accuracy grades (=0.35). Only the top screws were included in the analysis of FJVs. The percentages of FJV (Babu grades 1, 2, and 3) were 5.6% and 28.3%, respectively. This difference was statistically significant (=0.01). Overall, the FJV grades in group RE-RO were significantly better than those in group GE-FLU (=0.009). The mean fluoroscopy time for each screw in group RE-RO was significantly shorter than that in group GE-FLU (group RE-RO: 5.4 ± 1.9 seconds and group GE-FLU: 6.8 ± 2.0 seconds; =0.03). The postoperative pain between the RE-RO and GE-FLU groups was not statistically significant. The intraoperative adverse events included 1 case of registration failure and 1 case of guide-wire dislodgment in group RE-RO, as well as 2 cases of screw misplacement in group GE-FLU. No complications related to anesthesia were observed.
Robot-assisted pedicle screw placement under regional anesthesia can be performed effectively and safely. The accuracy is comparable to the conventional technique. Moreover, this technique has the advantage of fewer FJVs and a lower radiation time.
机器人辅助椎弓根螺钉置钉术通常在全身麻醉下进行，以保持身体静止。本研究的目的是比较在区域麻醉下使用机器人辅助技术与在全身麻醉下使用传统透视引导经皮椎弓根螺钉置入术在微创腰椎融合术中的准确性。
本研究纳入了 2017 年 12 月至 2020 年 2 月在单中心接受机器人辅助经皮内镜腰椎间融合术（PELIF）或透视引导微创经椎间孔腰椎间融合术（MIS-TLIF）的患者。根据经皮椎弓根螺钉置入方法，患者分为机器人辅助下区域麻醉（组 RE-RO）和透视引导下全身麻醉（组 GE-FLU）。主要观察指标为螺钉准确性和关节突关节侵犯（FJV）发生率。次要观察指标包括 X 线和视觉模拟量表（VAS）评分，用于评估术后 4 小时及术后第 1、2、3 天的术后疼痛程度。还记录了术中不良事件。
RE-RO 组纳入 18 例患者，GE-FLU 组纳入 23 例患者。临床可接受螺钉（Gertzbein 和 Robbins 分级 A 和 B）的比例分别为 94.4%和 91.5%。临床可接受螺钉的比例（=0.44）或总体 Gertzbein 和 Robbins 螺钉准确性分级（=0.35）无显著差异。仅对 FJVs 进行了顶部螺钉的分析。FJV（Babu 分级 1、2 和 3）的比例分别为 5.6%和 28.3%。差异具有统计学意义（=0.01）。总体而言，RE-RO 组的 FJV 分级明显优于 GE-FLU 组（=0.009）。RE-RO 组每个螺钉的透视时间明显短于 GE-FLU 组（RE-RO 组：5.4±1.9 秒，GE-FLU 组：6.8±2.0 秒；=0.03）。RE-RO 组和 GE-FLU 组的术后疼痛无统计学意义。RE-RO 组术中不良事件包括 1 例配准失败和 1 例导丝移位，GE-FLU 组 2 例螺钉位置不当。未观察到与麻醉相关的并发症。
区域麻醉下机器人辅助椎弓根螺钉置钉术可有效、安全地进行。准确性与传统技术相当。此外，该技术具有 FJV 少和辐射时间短的优点。
