Shahi Pratyush, Maayan Omri, Shinn Daniel, Dalal Sidhant, Song Junho, Araghi Kasra, Melissaridou Dimitra, Vaishnav Avani, Shafi Karim, Pompeu Yuri, Sheha Evan, Dowdell James, Iyer Sravisht, Qureshi Sheeraz A
Hospital for Special Surgery, New York, NY, USA.
Weill Cornell Medical College, New York, NY, USA.
Neurospine. 2023 Jun;20(2):577-586. doi: 10.14245/ns.2346070.035. Epub 2023 Jun 30.
To analyze the usage of floor-mounted robot in minimally invasive lumbar fusion.
Patients who underwent minimally invasive lumbar fusion for degenerative pathology using floor-mounted robot (ExcelsiusGPS) were included. Pedicle screw accuracy, proximal level violation rate, pedicle screw size, screw-related complications, and robot abandonment rate were analyzed.
Two hundred twenty-nine patients were included. Most surgeries were primary single-level fusion. Sixty-five percent of surgeries had intraoperative computed tomography (CT) workflow, 35% had preoperative CT workflow. Sixty-six percent were transforaminal lumbar interbody fusion, 16% were lateral, 8% were anterior, and 10% were a combined approach. A total of 1,050 screws were placed with robotic assistance (85% in prone position, 15% in lateral position). Postoperative CT scan was available for 80 patients (419 screws). Overall pedicle screw accuracy rate was 96.4% (prone, 96.7%; lateral, 94.2%; primary, 96.7%; revision, 95.3%). Overall poor screw placement rate was 2.8% (prone, 2.7%; lateral, 3.8%; primary, 2.7%; revision, 3.5%). Overall proximal facet and endplate violation rates were 0.4% and 0.9%. Average diameter and length of pedicle screws were 7.1 mm and 47.7 mm. Screw revision had to be done for 1 screw (0.1%). Use of the robot had to be aborted in 2 cases (0.8%).
Usage of floor-mounted robotics for the placement of lumbar pedicle screws leads to excellent accuracy, large screw size, and negligible screw-related complications. It does so for screw placement in prone/lateral position and primary/revision surgery alike with negligible robot abandonment rates.
分析落地式机器人在微创腰椎融合术中的应用情况。
纳入使用落地式机器人（ExcelsiusGPS）进行退行性病变微创腰椎融合术的患者。分析椎弓根螺钉置入准确性、近端节段侵犯率、椎弓根螺钉尺寸、螺钉相关并发症及机器人放弃率。
共纳入229例患者。大多数手术为初次单节段融合。65%的手术采用术中计算机断层扫描（CT）流程，35%采用术前CT流程。66%为经椎间孔腰椎椎间融合术，16%为外侧入路，8%为前路，10%为联合入路。在机器人辅助下共置入1050枚螺钉（85%为俯卧位，15%为侧卧位）。80例患者（419枚螺钉）术后可行CT扫描。总体椎弓根螺钉置入准确率为96.4%（俯卧位96.7%；侧卧位94.2%；初次手术96.7%；翻修手术95.3%）。总体螺钉置入不佳率为2.8%（俯卧位2.7%；侧卧位3.8%；初次手术2.7%；翻修手术3.5%）。总体近端小关节和终板侵犯率分别为0.4%和0.9%。椎弓根螺钉平均直径和长度分别为7.1mm和47.7mm。1枚螺钉（0.1%）需行螺钉翻修。2例（0.8%）手术中不得不放弃使用机器人。
使用落地式机器人置入腰椎椎弓根螺钉可获得极高的准确性、较大的螺钉尺寸，且螺钉相关并发症可忽略不计。无论是在俯卧位/侧卧位还是初次手术/翻修手术中进行螺钉置入，机器人放弃率均极低。
