Lopez Ignacio Barrio, Benzakour Ahmed, Mavrogenis Andreas, Benzakour Thami, Ahmad Alaaeldin, Lemée Jean-Michel
Department of Neurosurgery, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 09, France.
Centre Orléanais du Dos, Pôle Santé Oréliance, Saran, France.
Int Orthop. 2023 Feb;47(2):447-456. doi: 10.1007/s00264-022-05508-9. Epub 2022 Jul 18.
Over 4.83 million spine surgery procedures are performed annually around the world. With the considerable caseload and the precision needed to achieve optimal spinal instrumentation, technical progress has helped to improve the technique's safety and accuracy with the development of peri-operative assistance tools. Contrary to other surgical applications already part of the standard of care, the development of robotics in spine surgery is still a novelty and is not widely available nor used. Robotics, especially when coupled with other guidance modalities such as navigation, seems to be a promising tool in our quest for accuracy, improving patient outcomes and reducing surgical complications. Robotics in spine surgery may also be for the surgeon a way to progress in terms of ergonomics, but also to respond to a growing concern among surgical teams to reduce radiation exposure.
We present in this recent systematic review of the literature realized according to the PRISMA guidelines the place of robotics in spine surgery, reviewing the comparison to standard techniques, the current and future indications, the learning curve, the impact on radiation exposure, and the cost-effectiveness.
Seventy-six relevant original studies were identified and analyzed for the review.
Robotics has proved to be a safe help for spine surgery, both for the patient with a decrease of operating time and increase in pedicular screw accuracy, and for the surgical team with a decrease of radiation exposure. Medico-economic studies demonstrated that despite a high buying cost, the purchase of a robot dedicated for spine surgery is cost-effective resulting in lesser revision, lower infection, reduced length of stay, and shorter surgical procedure.
全球每年进行超过483万例脊柱手术。鉴于手术量可观且实现最佳脊柱内固定需要高精度，随着围手术期辅助工具的发展，技术进步有助于提高该技术的安全性和准确性。与已成为护理标准一部分的其他外科应用不同，脊柱手术中机器人技术的发展仍是一项新技术，尚未广泛应用。机器人技术，尤其是与导航等其他引导方式结合使用时，似乎是我们追求精确性、改善患者预后和减少手术并发症的一种有前景的工具。脊柱手术中的机器人技术对外科医生来说，可能也是一种在人体工程学方面取得进步的方式，同时也能回应手术团队对减少辐射暴露的日益关注。
我们在本次根据PRISMA指南对文献进行的最新系统评价中阐述了机器人技术在脊柱手术中的地位，回顾了与标准技术的比较、当前和未来的适应症、学习曲线、对辐射暴露的影响以及成本效益。
共识别并分析了76项相关的原始研究用于本次评价。
事实证明，机器人技术对脊柱手术是一种安全的辅助手段，对患者而言可减少手术时间并提高椎弓根螺钉置入的准确性，对手术团队而言可减少辐射暴露。医学经济学研究表明，尽管购买成本高昂，但购买一台专门用于脊柱手术的机器人具有成本效益，可减少翻修、降低感染率、缩短住院时间并缩短手术过程。
