Margalit Adam, Phalen Henry, Gao Cong, Ma Justin, Suresh Krishna V, Jain Punya, Farvardin Amirhossein, Taylor Russell H, Armand Mehran, Chattre Akhil, Jain Amit
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Johns Hopkins Whiting School of Engineering, Laboratory for Computational Sensing and Robotics, Baltimore, MD, USA.
Global Spine J. 2024 Jan;14(1):138-145. doi: 10.1177/21925682221096625. Epub 2022 Apr 25.
Phantom study.
The aim of our study is to demonstrate in a proof-of-concept model whether the use of a marker less autonomous robotic controlled injection delivery system will increase accuracy in the lumbar spine.
Ideal transforaminal epidural injection trajectories (bilateral L2/3, L3/4, L4/5, L5/S1 and S1) were planned out on a virtual pre-operative planning software by 1 experienced provider. Twenty transforaminal epidural injections were administered in a lumbar spine phantom model, 10 using a freehand procedure, and 10 using a marker less autonomous spinal robotic system. Procedural accuracy, defined as the difference between pre-operative planning and actual post-operative needle tip distance (mm) and angular orientation (degrees), were assessed between the freehand and robotic procedures.
Procedural accuracy for robotically placed transforaminal epidural injections was significantly higher with the difference in pre- and post-operative needle tip distance being 20.1 (±5.0) mm in the freehand procedure and 11.4 (±3.9) mm in the robotically placed procedure ( < .001). Needle tip precision for the freehand technique was 15.6 mm (26.3 - 10.7) compared to 10.1 mm (16.3 - 6.1) for the robotic technique. Differences in needle angular orientation deviation were 5.6 (±3.3) degrees in the robotically placed procedure and 12.0 (±4.8) degrees in the freehand procedure ( = .003).
The robotic system allowed for comparable placement of transforaminal epidural injections as a freehand technique by an experienced provider, with additional benefits of improved accuracy and precision.
体模研究。
我们研究的目的是在一个概念验证模型中证明，使用无标记自主机器人控制的注射给药系统是否会提高腰椎穿刺的准确性。
由1名经验丰富的医疗人员在虚拟术前规划软件上规划出理想的经椎间孔硬膜外注射轨迹（双侧L2/3、L3/4、L4/5、L5/S1和S1）。在腰椎体模模型中进行了20次经椎间孔硬膜外注射，10次采用徒手操作，10次采用无标记自主脊柱机器人系统。评估了徒手操作和机器人操作之间的操作准确性，操作准确性定义为术前规划与术后实际针尖距离（毫米）和角度方向（度）之间的差异。
机器人放置的经椎间孔硬膜外注射的操作准确性显著更高，徒手操作的术前和术后针尖距离差异为20.1（±5.0）毫米，机器人放置操作的差异为11.4（±3.9）毫米（<0.001）。徒手技术的针尖精度为15.6毫米（26.3 - 10.7），而机器人技术为10.1毫米（16.3 - 6.1）。机器人放置操作的针角度方向偏差差异为5.6（±3.3）度，徒手操作的差异为12.0（±4.8）度（P = 0.003）。
机器人系统与经验丰富的医疗人员徒手技术相比，能够实现类似的经椎间孔硬膜外注射放置，且具有提高准确性和精度的额外优势。
