Department of Orthopedics, Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, Anhui, China.
BMC Surg. 2022 Jul 24;22(1):284. doi: 10.1186/s12893-022-01733-6.
The superiorities in proximal facet joint protection of robot-assisted (RA) pedicle screw placement and screw implantation via the cortical bone trajectory (CBT) have rarely been compared. Moreover, findings on the screw accuracy of both techniques are inconsistent. Therefore, we analyzed the screw accuracy and incidence of facet joint violation (FJV) of RA and CBT screw insertion in the same study and compared them with those of conventional pedicle screw (PS) insertion. The possible factors affecting screw accuracy and FJV were also analyzed.
A total of 166 patients with lumbar degenerative diseases requiring posterior L4-5 fusion were retrospectively included and divided into the RA, PS, and CBT groups from March 2019 to December 2021. The grades of intrapedicular accuracy and superior FJV were evaluated according to the Gertzbin-Robbins scale and the Babu scale based on postoperative CT. Univariable and multivariable analyses were conducted to assess the possible risk factors associated with intrapedicular accuracy and superior FJV.
The rates of optimal screw insertion in the RA, PS, and CBT groups were 87.3%, 81.3%, and 76.5%, respectively. The difference between the RA and CBT groups was statistically significant (P = 0.004). Superior FJVs occurred in 28.2% of screws in RA, 45.0% in PS, and 21.6% in CBT. The RA and CBT groups had fewer superior FJVs than the PS group (P = 0.008 and P < 0.001, respectively), and no significant difference was observed between the RA and CBT groups (P = 0.267). Multivariable analysis revealed that the CBT technique was an independent risk factor for intrapedicular accuracy. Furthermore, older age, the conventional PS technique and a smaller facet angle were independently associated with the incidence of superior FJVs.
The RA and CBT techniques were associated with fewer proximal FJVs than the PS technique. The RA technique showed a higher rate of intrapedicular accuracy than the CBT technique. The CBT technique was independently associated with screw inaccuracy. Older age, conventional PS technique and coronal orientation of the facet join were independent risk factors for superior FJV.
机器人辅助（RA）经皮螺钉置入和皮质骨轨迹（CBT）螺钉植入在保护近节段关节突方面的优势鲜有比较。此外，这两种技术的螺钉准确性研究结果也不一致。因此，我们在同一研究中分析了 RA 和 CBT 螺钉置入的螺钉准确性和关节突侵犯（FJV）发生率，并与传统经皮螺钉（PS）置入进行了比较。还分析了可能影响螺钉准确性和 FJV 的因素。
回顾性纳入 2019 年 3 月至 2021 年 12 月因腰椎退行性疾病需要后路 L4-5 融合的 166 例患者，根据术后 CT 按照 Gertzbin-Robbins 分级和 Babu 分级，将患者分为 RA、PS 和 CBT 组，评估椎弓根内准确性和上关节突 FJV 分级。采用单变量和多变量分析评估与椎弓根内准确性和上关节突 FJV 相关的可能危险因素。
RA、PS 和 CBT 组的最佳螺钉置入率分别为 87.3%、81.3%和 76.5%，RA 和 CBT 组之间的差异具有统计学意义（P=0.004）。RA 组、PS 组和 CBT 组的上关节突 FJV 发生率分别为 28.2%、45.0%和 21.6%。RA 和 CBT 组的上关节突 FJV 发生率低于 PS 组（P=0.008 和 P<0.001），但 RA 和 CBT 组之间无显著差异（P=0.267）。多变量分析显示，CBT 技术是椎弓根内准确性的独立危险因素。此外，年龄较大、传统 PS 技术和小关节角度与上关节突 FJV 的发生率独立相关。
与 PS 技术相比，RA 和 CBT 技术与近节段关节突 FJV 发生率较低相关。RA 技术的椎弓根内准确性高于 CBT 技术。CBT 技术与螺钉不准确独立相关。年龄较大、传统 PS 技术和冠状面关节突方向是上关节突 FJV 的独立危险因素。
