Bhimreddy Meghana, Hersh Andrew M, Jiang Kelly, Weber-Levine Carly, Davidar A Daniel, Menta Arjun K, Judy Brendan F, Lubelski Daniel, Bydon Ali, Weingart Jon, Theodore Nicholas
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Int J Spine Surg. 2024 Nov 26;18(6):712-20. doi: 10.14444/8660.
Robotic platforms have increased in sophistication for pedicle screw placement. Here, we review our institutional experience using ExcelsiusGPS to assess the accuracy rate of pedicle screw placement throughout the spine and characterize predictors of placement inaccuracy.
Retrospective cohort study.
Patients from 2017 to 2022 undergoing spinal fusion surgery with ExelsiusGPS-assisted screw implantation at a single tertiary center were retrospectively identified. Patient demographics, preoperative symptoms, and operative details were collected. Postoperative computed tomography was used to classify screw placement accuracy according to the Gertzbein and Robbins scale (GRS). A stepwise multivariable ordered logistic regression analysis determined independent risk factors for clinically inaccurate screws (GRS C/D/E).
One hundred and seventeen patients were included. Mean age was 60.6 ± 13.2 years, with 57% men, 72% white, and mean body mass index of 29.9 ± 6.4 kg/m. Seven hundred and twenty-eight screws were placed, predominantly in the thoracic (29.5%) and lumbar (52.6%) regions. Accuracy classification indicated 670 GRS A, 31 GRS B, 22 GRS C, 4 GRS D, and 1 GRS E screws. The clinically acceptable screw placement rate (GRS A/B) was 96%. Male gender (odds ratio [OR]: 2.12, = 0.03), revision surgery (OR: 2.43, = 0.02), and thoracic level screw insertion (OR: 2.33, = 0.01) were independently associated with inaccurate screw placement and explained 8.7% of the variability seen. Of the 728 screws placed, 3 required revision after postoperative imaging revealed loosening or pedicle breach.
ExcelsiusGPS-assisted screw insertion has high placement accuracy and low revision rates. Identification of predictors of inaccuracy illustrates that similar variables, such as placement in the thoracic spine and revision surgery status, apply to both freehand and robotic screw placement.
Robotic spine surgery is an accurate, reliable tool that can improve patient outcomes. Factors like male gender, thoracic screw placement, and revision surgery status are associated with lower screw placement accuracy, and these factors should inform surgical decision-making when using robotic assistance.
用于椎弓根螺钉置入的机器人平台已日益复杂。在此，我们回顾了我们机构使用ExcelsiusGPS评估全脊柱椎弓根螺钉置入准确率并确定置入不准确的预测因素的经验。
回顾性队列研究。
回顾性确定2017年至2022年在单一三级中心接受ExcelsiusGPS辅助螺钉植入的脊柱融合手术患者。收集患者人口统计学资料、术前症状和手术细节。术后计算机断层扫描用于根据Gertzbein和Robbins量表（GRS）对螺钉置入准确性进行分类。逐步多变量有序逻辑回归分析确定临床不准确螺钉（GRS C/D/E）的独立危险因素。
纳入117例患者。平均年龄为60.6±13.2岁，男性占57%，白人占72%，平均体重指数为29.9±6.4kg/m²。共置入728枚螺钉，主要位于胸椎（29.5%）和腰椎（52.6%）区域。准确性分类显示有670枚GRS A级螺钉、31枚GRS B级螺钉、22枚GRS C级螺钉、4枚GRS D级螺钉和1枚GRS E级螺钉。临床可接受的螺钉置入率（GRS A/B）为96%。男性（优势比[OR]：2.12，P = 0.03）、翻修手术（OR：2.43，P = 0.02）和胸椎节段螺钉置入（OR：2.33，P = 0.01）与螺钉置入不准确独立相关，并解释了8.7%的观察到的变异性。在置入的728枚螺钉中，术后影像学显示松动或椎弓根破裂后有3枚需要翻修。
ExcelsiusGPS辅助螺钉置入具有高置入准确率和低翻修率。对不准确预测因素的识别表明，类似的变量，如胸椎置入和翻修手术状态，适用于徒手和机器人螺钉置入。
机器人脊柱手术是一种准确、可靠的工具，可改善患者预后。男性性别、胸椎螺钉置入和翻修手术状态等因素与较低的螺钉置入准确率相关，在使用机器人辅助时，这些因素应指导手术决策。
