Ha Byeong-Jin, Lee Jong-Min, Yoon Seon-Jin, Kim Byung-Kwan, Lee Junseok, Lee Suhun, Ryu Seungjae, Cha Yongyeob, Hwang Sungteac, Woo Donggi, Lee Chang Kyu, Shin Dong Ah, Ha Yoon, Kuh Sung Uk, Kim Keung Nyun, Son Dongwuk, Yi Seong
Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea.
Neurospine. 2023 Sep;20(3):1028-1039. doi: 10.14245/ns.2346552.276. Epub 2023 Sep 30.
The objective of this study was to evaluate the accuracy of pedicle screw placement in patients undergoing percutaneous pedicle screw fixation with robotic guidance, using a newly developed 3-dimensional quantitative measurement system. The study also aimed to assess the clinical feasibility of the robotic system in the field of spinal surgery.
A total of 113 patients underwent pedicle screw insertion using the CUVIS-spine pedicle screw guide system (CUREXO Inc.). Intraoperative O-arm images were obtained, and screw insertion pathways were planned accordingly. Image registration was performed using paired-point registration and iterative closest point methods. The accuracy of the robotic-guided pedicle screw insertion was assessed using 3-dimensional offset calculation and the Gertzbein-Robbins system (GRS).
A total of 448 screws were inserted in the 113 patients. The image registration success rate was 95.16%. The average error of entry offset was 2.86 mm, target offset was 2.48 mm, depth offset was 1.99 mm, and angular offset was 3.07°. According to the GRS grading system, 88.39% of the screws were classified as grade A, 9.60% as grade B, 1.56% as grade C, 0.22% as grade D, and 0.22% as grade E. Clinically acceptable screws (GRS grade A or B) accounted for 97.54% of the total, with no reported neurologic complications.
Our study demonstrated that pedicle screw insertion using the novel robot-assisted navigation method is both accurate and safe. Further prospective studies are necessary to explore the potential benefits of this robot-assisted technique in comparison to conventional approaches.
本研究的目的是使用新开发的三维定量测量系统，评估在机器人引导下接受经皮椎弓根螺钉固定的患者中椎弓根螺钉置入的准确性。该研究还旨在评估机器人系统在脊柱外科领域的临床可行性。
共有113例患者使用CUVIS-spine椎弓根螺钉导向系统（CUREXO公司）进行椎弓根螺钉置入。术中获取O型臂图像，并据此规划螺钉置入路径。使用配对点配准和迭代最近点方法进行图像配准。使用三维偏移计算和Gertzbein-Robbins系统（GRS）评估机器人引导的椎弓根螺钉置入的准确性。
113例患者共置入448枚螺钉。图像配准成功率为95.16%。进针偏移的平均误差为2.86mm，靶点偏移为2.48mm，深度偏移为1.99mm，角度偏移为3.07°。根据GRS分级系统，88.39%的螺钉被分类为A级，9.60%为B级，1.56%为C级，0.22%为D级，0.22%为E级。临床可接受的螺钉（GRS A级或B级）占总数的97.54%，未报告神经并发症。
我们的研究表明，使用新型机器人辅助导航方法进行椎弓根螺钉置入既准确又安全。与传统方法相比，有必要进行进一步的前瞻性研究以探索这种机器人辅助技术的潜在益处。
