Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.
Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China.
J Bone Joint Surg Am. 2023 Jun 21;105(12):943-950. doi: 10.2106/JBJS.22.01320. Epub 2023 Mar 21.
BACKGROUND: The main function of robots in spine surgery is to assist with pedicle screw placement. Laminectomy, which is as important as pedicle screw placement, lacks a mature robot-assisted system. The aims of this study were to introduce the first autonomous laminectomy robot, to explore the feasibility of autonomous robotic laminectomy, and to validate its accuracy using a cadaveric model. METHODS: Forty vertebrae from 4 cadavers were included in the study; 7 thoracic and 3 lumbar vertebrae were randomly selected in each cadaver. The surgeon was able to plan the laminectomy path based on computed tomographic (CT) data before the surgical procedure. The robot performed the laminectomy autonomously, and a postoperative CT scan was made. The deviation of each cutting plane from the plan was quantitatively analyzed, and the accuracy and safety were qualitatively evaluated. The time required for the laminectomy was also recorded. RESULTS: Cuts were performed in 80 laminectomy planes (56 for thoracic vertebrae and 24 for lumbar vertebrae). The mean time for 1-sided laminectomy was 333.59 ± 116.49 seconds, which was shorter for thoracic vertebrae (284.41 ± 66.04 seconds) than lumbar vertebrae (448.33 ± 128.65 seconds) (p < 0.001). The mean time for single-level total laminectomy was 814.05 ± 302.23 seconds, which was also shorter for thoracic vertebrae (690.46 ± 165.74 seconds) than lumbar vertebrae (1,102.42 ± 356.13 seconds) (p = 0.002). The mean deviation of the cutting plane from the plan was 0.67 ± 0.30 mm for the most superior cutting point and 0.73 ± 0.31 mm for the most inferior point. There were no significant differences in the deviation between thoracic vertebrae (0.66 ± 0.26 mm) and lumbar vertebrae (0.67 ± 0.38 mm) at the superior cutting point (p = 0.908) and between thoracic vertebrae (0.72 ± 0.30 mm) and lumbar vertebrae (0.73 ± 0.33 mm) at the inferior cutting point (p = 0.923). In the qualitative analysis of the accuracy of the 80 laminectomy planes, 66 (83%) were classified as grade A, 14 (18%) were grade B, and none was grade C. In the safety analysis, 65 planes (81%) were considered safe and the safety of the other 15 planes (19%) was considered uncertain. CONCLUSIONS: The results confirmed the accuracy of this robotic system, supporting its use for laminectomy of thoracolumbar vertebrae. LEVEL OF EVIDENCE: Therapeutic Level V . See Instructions for Authors for a complete description of levels of evidence.
背景：机器人在脊柱手术中的主要功能是协助进行椎弓根螺钉放置。与椎弓根螺钉放置同样重要的是，椎板切除术缺乏成熟的机器人辅助系统。本研究的目的是介绍第一个自主式椎板切除术机器人，探索自主式机器人椎板切除术的可行性，并使用尸体模型验证其准确性。
方法：本研究纳入了 4 具尸体的 40 个椎体；每个尸体中随机选择 7 个胸椎和 3 个腰椎。在手术前，外科医生可以根据计算机断层扫描（CT）数据规划椎板切除术路径。机器人自主进行椎板切除术，然后进行术后 CT 扫描。从计划中定量分析每个切割平面的偏差，并定性评估准确性和安全性。还记录了椎板切除术所需的时间。
结果：在 80 个椎板切除平面（56 个胸椎和 24 个腰椎）中进行了切割。单侧椎板切除术的平均时间为 333.59±116.49 秒，胸椎（284.41±66.04 秒）的时间短于腰椎（448.33±128.65 秒）（p<0.001）。单节段全椎板切除术的平均时间为 814.05±302.23 秒，胸椎（690.46±165.74 秒）的时间也短于腰椎（1102.42±356.13 秒）（p=0.002）。最上切割点的切割平面与计划的平均偏差为 0.67±0.30mm，最下切割点的平均偏差为 0.73±0.31mm。在上切割点，胸椎（0.66±0.26mm）和腰椎（0.67±0.38mm）之间的偏差（p=0.908）以及在下切割点，胸椎（0.72±0.30mm）和腰椎（0.73±0.33mm）之间的偏差（p=0.923）均无显著差异。在 80 个椎板切除术平面准确性的定性分析中，66 个（83%）被分类为 A 级，14 个（18%）为 B 级，没有 C 级。在安全性分析中，65 个平面（81%）被认为是安全的，其余 15 个平面（19%）的安全性不确定。
结论：结果证实了该机器人系统的准确性，支持其用于胸腰椎椎板切除术。
证据水平：治疗性级别 V。有关证据水平的完整描述，请参见作者说明。
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