Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA; Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA.
Spine J. 2024 Jan;24(1):118-124. doi: 10.1016/j.spinee.2023.09.004. Epub 2023 Sep 12.
Navigation and robotic technologies have emerged as an alternative option to conventional freehand techniques for pedicle screw insertion. However, the effectiveness of these technologies in reducing the perioperative complications of spinal fusion surgery remains limited due to the small cohort size in the existing literature.
To investigate whether utilization of robotically navigated pedicle screw insertion can reduce the perioperative complications of spinal fusion surgery-including reoperations-with a sizeable cohort.
Retrospective study.
Patients who underwent primary lumbar fusion surgery between 2019 and 2022.
Perioperative complications including readmission, reoperation, its reasons, estimated blood loss, operative time, and length of hospital stay.
Patients' data were collected including age, sex, race, body mass index, upper-instrumented vertebra, lower-instrumented vertebra, number of screws inserted, and primary procedure name. Patients were classified into the following two groups: freehand group and robot group. The variable-ratio greedy matching was utilized to create the matched cohorts by propensity score and compared the outcomes between the two group.
A total of 1,633 patients who underwent primary instrumented spinal lumbar fusion surgery were initially identified (freehand 1,286; robot 347). After variable ratio matching was performed with age, sex, body mass index, fused levels, and upper instrumented vertebrae level, 694 patients in the freehand group and 347 patients in robot groups were selected. The robot group showed less estimated blood loss (418.9±398.9 vs 199.2±239.6 ml; p<.001), shorter LOS (4.1±3.1 vs 3.2±3.0 days; p<.001) and similar operative time (212.5 vs 222.0 minutes; p=.151). Otherwise, there was no significant difference in readmission rate (3.6% vs 2.6%; p=.498), reoperation rate (3.2% vs 2.6%; p=.498), and screw malposition requiring reoperation (five cases, 0.7% vs one case, 0.3%; p=1.000).
Perioperative complications requiring readmission and reoperation were similar between fluoroscopy guided freehand and robotic surgery. Robot-guided pedicle screw insertion can enhance surgical efficiency by reducing intraoperative blood loss and length of hospital stay without extending operative time.
导航和机器人技术已成为传统徒手技术的替代选择，用于椎弓根螺钉置入。然而，由于现有文献中小队列的数量有限，这些技术在减少脊柱融合手术围手术期并发症方面的效果仍然有限。
研究机器人导航椎弓根螺钉置入是否可以减少脊柱融合手术的围手术期并发症——包括再次手术——在一个相当大的队列中。
回顾性研究。
2019 年至 2022 年间接受原发性腰椎融合手术的患者。
共纳入 1633 例接受原发性器械性脊柱腰椎融合术的患者（徒手组 1286 例，机器人组 347 例）。在使用倾向评分进行变量比例贪婪匹配创建匹配队列后，比较了两组之间的结果。
机器人组的失血量估计（418.9±398.9 vs 199.2±239.6 ml；p<.001）、住院时间（4.1±3.1 vs 3.2±3.0 天；p<.001）和手术时间（212.5 vs 222.0 分钟；p=.151）相似，但再次入院率（3.6% vs 2.6%；p=.498）、再次手术率（3.2% vs 2.6%；p=.498）和需要再次手术的螺钉位置不当（5 例，0.7% vs 1 例，0.3%；p=1.000）无显著差异。
透视引导下徒手和机器人手术的围手术期并发症相似。机器人引导的椎弓根螺钉置入可以通过减少术中失血量和住院时间来提高手术效率，而不会延长手术时间。
