机器人导航辅助下降低胸椎椎弓根螺钉置钉偏差率。

Decreasing the Pedicle Screw Misplacement Rate in the Thoracic Spine With Robot-guided Navigation.

机构信息

Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX.

Musculoskeletal Education and Research Center (MERC), Audubon, PA.

出版信息

Clin Spine Surg. 2023 Dec 1;36(10):431-437. doi: 10.1097/BSD.0000000000001474. Epub 2023 Jun 16.

DOI:10.1097/BSD.0000000000001474

PMID:37348067

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10681281/

Abstract

STUDY DESIGN

A retrospective chart review.

OBJECTIVE

The aim of this study was to evaluate the screw accuracy of thoracic pedicle screws placed with a robot-guided navigation system.

SUMMARY OF BACKGROUND DATA

Thoracic pedicles are smaller in diameter than lumbar pedicles, making pedicle screw placement difficult. Misplaced pedicle screws may present complications including decreased construct stability, and increased risks of neurological deficits and blood vessel perforation. There is a dearth of knowledge on thoracic pedicle screw accuracy placed with a robot.

MATERIALS AND METHODS

A retrospective analysis of the robot-assisted placement of thoracic pedicle screws was performed. Preoperative and postoperative computed tomography (CT) scans of the implanted thoracic screws were collected to assess screw placement accuracy, pedicle breadth, and placement deviations. A CT-based Gertzbein and Robbins System was used to classify pedicle screw accuracy in 2 mm increments. A custom image overlay software was used to determine the deviations between the preoperatively planned trajectory of pedicle screws and final placement at screw entry (tail), and tip in addition to the angular deviation.

RESULTS

Seventy-five thoracic pedicle screws were implanted by navigated robotic guidance in 17 patients, only 1.3% (1/75) were repositioned intraoperatively. Average patient age and body mass index were 57.5 years and 25.9 kg/m 2 , respectively, with 52.9% female patients. Surgery diagnoses were degenerative disk disease (47.1%) and adjacent segment disease (17.6%). There were zero complications, with no returns to the operating room. According to the CT-based Gertzbein and Robbins pedicle screw breach classification system, 93.3% (70/75) screws were grade A or B, 6.6% (5/75) were grade C, and 0% were grade D or E. The average deviation from the preoperative plan to actual final placement was 1.8±1.3 mm for the screw tip, 1.6±0.9 mm for the tail, and 2.1±1.5 degrees of angulation.

CONCLUSIONS

The current investigation found a 93.3% accuracy of pedicle screw placement in the thoracic spine. Navigated robot assistance is a useful system for placing screws in the smaller pedicles of the thoracic spine.

LEVEL OF EVIDENCE

Level III-retrospective nonexperimental study.

摘要

研究设计

回顾性图表审查。

目的

本研究旨在评估使用机器人导航系统进行胸椎椎弓根螺钉固定的螺钉准确性。

背景资料概要

胸椎椎弓根比腰椎椎弓根直径小，使得椎弓根螺钉固定变得困难。放置不当的椎弓根螺钉可能会出现并发症，包括降低结构稳定性，并增加神经功能缺损和血管穿孔的风险。目前对于使用机器人放置胸椎椎弓根螺钉的准确性知之甚少。

材料与方法

对机器人辅助胸椎椎弓根螺钉植入的回顾性分析。收集植入的胸椎螺钉的术前和术后 CT 扫描，以评估螺钉放置的准确性、椎弓根宽度和放置偏差。使用基于 CT 的 Gertzbein 和 Robbins 系统以 2mm 增量对椎弓根螺钉的准确性进行分类。使用定制的图像叠加软件确定椎弓根螺钉术前计划轨迹与螺钉进入（尾部）和尖端最终位置之间的偏差，以及角度偏差。

结果

17 名患者共植入 75 枚胸椎椎弓根螺钉，仅 1.3%（1/75）需要术中重新定位。平均患者年龄和 BMI 分别为 57.5 岁和 25.9kg/m 2 ，女性占 52.9%。手术诊断为退行性椎间盘疾病（47.1%）和相邻节段疾病（17.6%）。无并发症，无需返回手术室。根据基于 CT 的 Gertzbein 和 Robbins 椎弓根螺钉穿透分类系统，93.3%（70/75）螺钉为 A 或 B 级，6.6%（5/75）为 C 级，0%为 D 或 E 级。从术前计划到实际最终放置，螺钉尖端的偏差平均为 1.8±1.3mm，尾部为 1.6±0.9mm，角度偏差为 2.1±1.5 度。