Neurosurg Focus. 2022 Jan;52(1):E4. doi: 10.3171/2021.10.FOCUS21526.
The accuracy of percutaneous pedicle screw placement has increased with the advent of robotic and surgical navigation technologies. However, the effect of robotic intraoperative screw size and trajectory templating remains unclear. The purpose of this study was to compare pedicle screw sizes and accuracy of placement using robotic navigation (RN) versus skin-based intraoperative navigation (ION) alone in minimally invasive lumbar fusion procedures.
A retrospective cohort study was conducted using a single-institution registry of spine procedures performed over a 4-year period. Patients who underwent 1- or 2-level primary or revision minimally invasive surgery (MIS)-transforaminal lumbar interbody fusion (TLIF) with pedicle screw placement, via either robotic assistance or surgical navigation alone, were included. Demographic, surgical, and radiographic data were collected. Pedicle screw type, quantity, length, diameter, and the presence of endplate breach or facet joint violation were assessed. Statistical analysis using the Student t-test and chi-square test was performed to evaluate the differences in pedicle screw sizes and the accuracy of placement between both groups.
Overall, 222 patients were included, of whom 92 underwent RN and 130 underwent ION MIS-TLIF. A total of 403 and 534 pedicle screws were placed with RN and ION, respectively. The mean screw diameters were 7.25 ± 0.81 mm and 6.72 ± 0.49 mm (p < 0.001) for the RN and ION groups, respectively. The mean screw length was 48.4 ± 4.48 mm in the RN group and 45.6 ± 3.46 mm in the ION group (p < 0.001). The rates of "ideal" pedicle screws in the RN and ION groups were comparable at 88.5% and 88.4% (p = 0.969), respectively. The overall screw placement was also similar. The RN cohort had 63.7% screws rated as good and 31.4% as acceptable, while 66.1% of ION-placed screws had good placement and 28.7% had acceptable placement (p = 0.661 and p = 0.595, respectively). There was a significant reduction in high-grade breaches in the RN group (0%, n = 0) compared with the ION group (1.2%, n = 17, p = 0.05).
The results of this study suggest that robotic assistance allows for placement of screws with greater screw diameter and length compared with surgical navigation alone, although with similarly high accuracy. These findings have implied that robotic platforms may allow for safe placement of the "optimal screw," maximizing construct stability and, thus, the ability to obtain a successful fusion.
随着机器人和手术导航技术的出现，经皮椎弓根螺钉置钉的准确性得到了提高。然而，机器人术中螺钉大小和轨迹模板的效果仍不清楚。本研究的目的是比较机器人导航（RN）与单纯皮肤术中导航（ION）在微创腰椎融合术中使用时螺钉大小和放置准确性。
对 4 年内单机构脊柱手术数据库进行回顾性队列研究。纳入接受经皮单侧或双侧经椎间孔腰椎体间融合术（TLIF）、采用机器人辅助或单纯手术导航行椎弓根螺钉置入的原发性或翻修性微创脊柱手术（MIS-TLIF）患者。收集患者的人口统计学、手术和影像学资料。评估椎弓根螺钉类型、数量、长度、直径以及有无终板破裂或关节突关节侵犯。采用 Student t 检验和卡方检验对两组患者的椎弓根螺钉大小和放置准确性进行统计学分析。
共纳入 222 例患者，其中 92 例行 RN，130 例行 ION-MIS-TLIF。分别使用 RN 和 ION 共置入 403 枚和 534 枚椎弓根螺钉。RN 组的平均螺钉直径为 7.25±0.81mm，ION 组为 6.72±0.49mm（p<0.001）。RN 组的平均螺钉长度为 48.4±4.48mm，ION 组为 45.6±3.46mm（p<0.001）。RN 组和 ION 组的“理想”椎弓根螺钉比例分别为 88.5%和 88.4%（p=0.969）。两组的总体螺钉放置情况也相似。RN 组螺钉的良好和可接受评级分别为 63.7%和 31.4%，ION 组分别为 66.1%和 28.7%（p=0.661 和 p=0.595）。RN 组的高级别破裂发生率为 0%（n=0），显著低于 ION 组的 1.2%（n=17，p=0.05）。
该研究结果表明，与单纯手术导航相比，机器人辅助可以置入更大直径和更长的螺钉，且具有同样高的准确性。这些发现表明，机器人平台可能能够安全地置入“最佳螺钉”，最大限度地提高结构稳定性，从而提高获得成功融合的能力。
