Diaz-Aguilar Luis Daniel, Brown Nolan J, Bui Nicholas, Alvandi Bejan, Pennington Zach, Gendreau Julian, Jeswani Sunil P, Pham Martin H, Santiago-Dieppa David R, Nguyen Andrew D
Department of Neurosurgery, University of California San Diego, La Jolla, CA, 92093 USA.
Department of Neurosurgery, University of California Irvine, Orange, CA, 92868 USA.
N Am Spine Soc J. 2023 Jun 12;15:100234. doi: 10.1016/j.xnsj.2023.100234. eCollection 2023 Sep.
Robotic assistance has been shown to increase instrumentation placement accuracy in open and minimally invasive spinal fusion. These gains have been achieved without increases in operative times, blood loss, or hospitalization duration. However, most work has been done in the degenerative population and little is known of the utility of robotic assistance when applied to spinal trauma. This is largely due to the uncertainty stemming from the disruption of normal anatomy by the traumatic injury. Since the robot depends upon registration for instrumentation guidance according to the fiducials it uses, trauma can introduce unique challenges. The present study sought to evaluate the safety and efficacy of robotic assistance in a consecutive cohort of spine trauma patients.
All patients with Thoracolumbar Injury Classification and Severity Scale (TLICS) >4 who underwent robot-assisted spinal fusion using the Globus ExcelsiusGPS at a single tertiary care center for trauma between 2020 and 2022 were identified. Demographic, clinical, and surgical data were collected and analyzed; the primary endpoints were operative time, fluoroscopy time, estimated blood loss, postoperative complications, admission time, and 90-day readmission rate. The paired t-test was used to compare differences between mean values when looking at the number of surgical levels.
Forty-two patients undergoing robot-assisted spinal surgery were included (mean age 61.3±17.1 year; 47% female. Patients were stratified by the number of operative levels, 2 (n = 10), 3-4 (n = 11), 5 to 6 (n = 13), or >6 (n = 8). There appeared to be a positive correlation between number of levels instrumented and odds of postoperative complications, admission duration, fluoroscopy time, and estimated blood loss. There were no instances of screw malposition or breach.
This initial experience suggests robotic assistance can be safely employed in the spine trauma population. Additional experiences in larger patient populations are necessary to delineate those traumatic pathologies most amenable to robotic assistance.
机器人辅助已被证明可提高开放性和微创脊柱融合术中器械置入的准确性。在不增加手术时间、失血量或住院时间的情况下实现了这些成效。然而，大多数研究是在退行性疾病患者中进行的，对于机器人辅助应用于脊柱创伤的效用了解甚少。这在很大程度上是由于创伤性损伤导致正常解剖结构破坏所带来的不确定性。由于机器人根据其使用的基准点进行器械引导依赖于配准，创伤会带来独特的挑战。本研究旨在评估机器人辅助在连续队列的脊柱创伤患者中的安全性和有效性。
确定了2020年至2022年期间在一家单一的三级创伤护理中心接受使用Globus ExcelsiusGPS机器人辅助脊柱融合术且胸腰椎损伤分类和严重程度评分（TLICS）>4的所有患者。收集并分析了人口统计学、临床和手术数据；主要终点是手术时间、透视时间、估计失血量、术后并发症、入院时间和90天再入院率。在观察手术节段数量时，使用配对t检验比较平均值之间的差异。
纳入了42例接受机器人辅助脊柱手术的患者（平均年龄61.3±17.1岁；47%为女性）。患者按手术节段数量分层，2个节段（n = 10）、3 - 4个节段（n = 11）、5至6个节段（n = 13）或>6个节段（n = 8）。手术节段数量与术后并发症几率、住院时间、透视时间和估计失血量之间似乎存在正相关。没有螺钉位置不当或穿透的情况。
这一初步经验表明机器人辅助可安全地应用于脊柱创伤患者群体。需要在更大的患者群体中积累更多经验，以确定最适合机器人辅助的创伤性病变。
