1Department of Neurological Surgery, University of California, Irvine, Orange.
2Department of Neurosurgery, UC San Diego School of Medicine, San Diego.
J Neurosurg Spine. 2022 Sep 9;38(1):66-74. doi: 10.3171/2022.7.SPINE22473. Print 2023 Jan 1.
Spinal robotics for thoracolumbar procedures, predominantly employed for the insertion of pedicle screws, is currently an emerging topic in the literature. The use of robotics in instrumentation of the cervical spine has not been broadly explored. In this review, the authors aimed to coherently synthesize the existing literature of intraoperative robotic use in the cervical spine and explore considerations for future directions and developments in cervical spinal robotics.
A literature search in the Web of Science, Scopus, and PubMed databases was performed for the purpose of retrieving all articles reporting on cervical spine surgery with the use of robotics. For the purposes of this study, randomized controlled trials, nonrandomized controlled trials, retrospective case series, and individual case reports were included. The Newcastle-Ottawa Scale was utilized to assess risk of bias of the studies included in the review. To present and synthesize results, data were extracted from the included articles and analyzed using the PyMARE library for effect-size meta-analysis.
On careful review, 6 articles published between 2016 and 2022 met the inclusion/exclusion criteria, including 1 randomized controlled trial, 1 nonrandomized controlled trial, 2 case series, and 2 case reports. These studies featured a total of 110 patients meeting the inclusion criteria (mean age 53.9 years, range 29-77 years; 64.5% males). A total of 482 cervical screws were placed with the use of a surgical robot, which yielded an average screw deviation of 0.95 mm. Cervical pedicle screws were the primary screw type used, at a rate of 78.6%. According to the Gertzbein-Robbins classification, 97.7% of screws in this review achieved a clinically acceptable grade. The average duration of surgery, blood loss, and postoperative length of stay were all decreased in minimally invasive robotic surgery relative to open procedures. Only 1 (0.9%) postoperative complication was reported, which was a surgical site infection, and the mean length of follow-up was 2.7 months. No mortality was reported.
Robot-assisted cervical screw placement is associated with acceptable rates of clinical grading, operative time, blood loss, and postoperative complications-all of which are equal to or improved relative to the metrics seen in the conventional use of fluoroscopy or computer-assisted navigation for cervical screw placement.
胸腰椎手术中使用的脊柱机器人主要用于置入椎弓根螺钉，目前是文献中的一个新兴话题。机器人在颈椎仪器中的应用尚未得到广泛探索。在这篇综述中，作者旨在综合现有文献中关于颈椎机器人术中应用的内容，并探讨颈椎脊柱机器人未来发展的考虑因素。
在 Web of Science、Scopus 和 PubMed 数据库中进行文献检索，以检索所有报告机器人辅助颈椎手术的文章。本研究纳入了随机对照试验、非随机对照试验、回顾性病例系列和单个病例报告。使用纽卡斯尔-渥太华量表评估纳入研究的偏倚风险。为了呈现和综合结果，从纳入的文章中提取数据，并使用 PyMARE 库进行效应量荟萃分析。
经过仔细审查，共有 6 篇发表于 2016 年至 2022 年的文章符合纳入/排除标准，包括 1 项随机对照试验、1 项非随机对照试验、2 项病例系列和 2 项病例报告。这些研究共纳入了 110 名符合纳入标准的患者（平均年龄 53.9 岁，范围 29-77 岁；男性占 64.5%）。共有 482 枚颈椎螺钉在手术机器人的辅助下植入，平均螺钉偏差为 0.95 毫米。颈椎椎弓根螺钉是主要使用的螺钉类型，占比为 78.6%。根据 Gertzbein-Robbins 分类，本研究中 97.7%的螺钉达到了临床可接受的等级。与开放手术相比，微创手术中手术时间、出血量和术后住院时间均有所减少。仅报告了 1 例（0.9%）术后并发症，为手术部位感染，平均随访时间为 2.7 个月。无死亡病例报告。
机器人辅助颈椎螺钉植入术具有可接受的临床分级、手术时间、出血量和术后并发症发生率，与传统使用透视或计算机辅助导航植入颈椎螺钉的指标相当或有所改善。
