Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan; Spine Center, St. Marianna University School of Medicine Hospital, Kawasaki, Japan.
Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan; Spine Center, St. Marianna University School of Medicine Hospital, Kawasaki, Japan.
J Orthop Sci. 2024 Jul;29(4):933-938. doi: 10.1016/j.jos.2023.06.003. Epub 2023 Jun 21.
The present study aimed to evaluate the safety of robot-assisted screw placement in 125 cases after introducing a spinal robotics system and to identify the situations where deviation was likely to occur.
The subjects were 125 consecutive patients who underwent robotic-assisted screw placement using a spinal robotics system (Mazor X Stealth Edition, Medtronic) from April 2021 to January 2023. The 1048 screws placed with robotic assistance were evaluated. We investigated intraoperative adverse events of the robotics system and complications occurring within 30 days after surgery. We evaluated screw accuracy and deviation and compared them for vertebral levels, screw insertion methods (open traditional pedicle screw [Open-PS], cortical bone trajectory screw [CBT], percutaneous pedicle screw [PPS], and S2 alar iliac screw [S2AIS]), diagnosis, and phases of surgical cases.
The deviation rate of robotic-assisted screw placement for spine surgery was 2.2%. Complications were reoperation due to implant-related neurological deficit in 0.8% and surgical site infection in 0.8%. There was significant difference in the deviation rate between vertebral levels. The deviation rate of the T1-T4 level was high at 10.0%. There was significant difference in the deviation rate between Open-PS, CBT, PPS, and S2AIS. The PPSs had a high deviation rate of 10.3%. The deviation rates were not significantly different between patients with and without deformity. The deviation rate did not change depending on the experience of surgical cases, and the deviation rate was favorable from the onset.
Although the robotic-assisted screw placement was safe, we should be extra vigilant when placing screws in the upper thoracic region (deviation rate 10.0%) and when using PPSs (deviation rate 10.3%).
本研究旨在评估引入脊柱机器人系统后 125 例机器人辅助螺钉固定的安全性，并确定可能发生偏差的情况。
本研究纳入了 2021 年 4 月至 2023 年 1 月期间使用脊柱机器人系统（美敦力 Mazor X Stealth Edition）行机器人辅助螺钉固定的 125 例连续患者。共评估了 1048 枚使用机器人辅助置入的螺钉。我们研究了机器人系统的术中不良事件和术后 30 天内发生的并发症。评估了螺钉的准确性和偏差，并比较了不同椎骨水平、螺钉插入方法（开放传统椎弓根螺钉[Open-PS]、皮质骨轨迹螺钉[CBT]、经皮椎弓根螺钉[PPS]和 S2 髂骨螺钉[S2AIS]）、诊断和手术阶段的螺钉偏差。
脊柱机器人辅助螺钉固定的偏差率为 2.2%。并发症包括与植入物相关的神经功能缺损的再次手术（0.8%）和手术部位感染（0.8%）。不同椎骨水平的偏差率有显著差异，T1-T4 水平的偏差率较高，为 10.0%。Open-PS、CBT、PPS 和 S2AIS 之间的偏差率有显著差异，PPS 的偏差率较高，为 10.3%。脊柱畸形患者与非脊柱畸形患者的偏差率无显著差异。手术病例经验对偏差率无影响，从一开始就呈现出良好的偏差率。
虽然机器人辅助螺钉固定是安全的，但在放置上胸段螺钉（偏差率 10.0%）和使用 PPS 时（偏差率 10.3%）应格外警惕。
