Altorfer Franziska C S, Kelly Michael J, Avrumova Fedan, Burkhard Marco D, Zhu Jiaqi, Abel Frederik, Cammisa Frank P, Sama Andrew, Farshad Mazda, Lebl Darren R
Department of Spine Surgery, Hospital for Special Surgery,523 East 72nd Street, New York, NY, USA.
Department of Biostatistics, Hospital for Special Surgery,523 East 72nd Street, New York, NY, USA.
Spine (Phila Pa 1976). 2024 Sep 4. doi: 10.1097/BRS.0000000000005147.
This was a single-center prospective clinical and radiographic analysis of pedicle screw instrumentation with Robotic-assisted navigation (RAN) and augmented reality (AR).
This study aimed to compare the accuracy of lumbosacral pedicle screw placement with RAN versus AR.
RAN and AR have demonstrated superior accuracy in lumbar pedicle screw placement compared to conventional free-hand techniques. RAN and AR techniques both tout specific advantages over their counterparts, but to date, no study has directly compared the two technologies regarding pedicle screw accuracy.
Patients who underwent RAN or head-mounted AR navigated lumbosacral (L1-S1) pedicle screw placement for degenerative conditions were included. Screw accuracy was assessed by two independent reviewers on intraoperative 3D fluoroscopic scans using the Gertzbein and Robbins scale. A generalized linear mixed model was applied to evaluate the relationship between the screw placement technique and accuracy.
212 patients undergoing lumbosacral instrumentation with a total of 1,211 pedicle screws placed using RAN (n=108; screws= 827) or AR (n=104; screws= 384). Overall, Grade A was achieved in 92.6% of screws. No significant difference was found between RAN and AR screw placement regarding the incidence of accurate (Grade-A and -B screws; RAN n=824; 99.6% and AR n=379, 98.7%) versus inaccurate screws (Grade-C and -D screws; RAN n=3, 0.4% and AR n=5, 1.3%). When comparing "optimal" Grade-A screws (RAN n= 787, 95.2%, AR n=345, 89.8%) versus all other screws (B, C, and D), significantly higher accuracy was achieved using RAN (P=0.001).
RAN and AR both achieved high accuracy in lumbosacral pedicle screw placement, proving reliable for this procedure. However, RAN resulted in significantly more Grade-A screw placements than AR.
这是一项对机器人辅助导航（RAN）和增强现实（AR）下椎弓根螺钉内固定术进行的单中心前瞻性临床及影像学分析。
本研究旨在比较RAN与AR在腰骶椎弓根螺钉置入的准确性。
与传统徒手技术相比，RAN和AR在腰椎椎弓根螺钉置入方面已显示出更高的准确性。RAN和AR技术相较于对方都有各自的特定优势，但迄今为止，尚无研究就椎弓根螺钉准确性直接比较这两种技术。
纳入因退行性疾病接受RAN或头戴式AR导航下腰骶部（L1-S1）椎弓根螺钉置入的患者。由两名独立 reviewers 使用Gertzbein和Robbins量表在术中三维透视扫描上评估螺钉准确性。应用广义线性混合模型评估螺钉置入技术与准确性之间的关系。
212例接受腰骶部内固定术的患者共置入1211枚椎弓根螺钉，其中使用RAN的患者108例（螺钉827枚），使用AR的患者104例（螺钉384枚）。总体而言，92.6%的螺钉达到A级。在准确（A级和B级螺钉；RAN组824枚，99.6%；AR组379枚，98.7%）与不准确螺钉（C级和D级螺钉；RAN组3枚，0.4%；AR组5枚，1.3%）的发生率方面，RAN和AR螺钉置入之间未发现显著差异。当比较“最佳”A级螺钉（RAN组787枚，95.2%；AR组345枚，89.8%）与所有其他螺钉（B级、C级和D级）时，RAN的准确性显著更高（P = 0.001）。
RAN和AR在腰骶椎弓根螺钉置入中均实现了高准确性，证明该手术可靠。然而，RAN获得A级螺钉置入的数量显著多于AR。
