1Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City; and.
2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.
Neurosurg Focus. 2024 Dec 1;57(6):E14. doi: 10.3171/2024.9.FOCUS24545.
As robot systems for spine surgery have been developed, they have demonstrated a high degree of accuracy in screw placement without sacrificing safety or surgical efficiency. These robotic systems offer preoperative planning and real-time feedback to enhance surgical precision and mitigate human error. Nevertheless, limitations to their optimal performance remain. The authors analyzed the initial 100 cases of pedicle screw placements performed using the Mazor X robot at their institution, presenting case examples to illustrate the limitations that were experienced, and reviewed current literature on the limitations of robot-assisted spine surgery, emphasizing their impact on accuracy and safety.
This was a retrospective review of the first 100 cases of robot-assisted pedicle screw placement at the authors' institution between December 2019 and June 2024. All intraoperative CT scans were reviewed for screw accuracy. Malpositioned screws, near misses (screw deviation without injury to the patient), or abandoned robot-assisted attempts were identified, and the underlying reasons were evaluated to determine the limitations of current robot technology.
Of the first 100 cases of robot-assisted pedicle screw placement, there were 20 screw-related complications, of which 14 were near misses, 1 involved neurological injury caused by screw malposition, and 5 were cases in which a robot-assisted attempt was abandoned before manual screw placement. The authors identified the following limitations with current robot technology: registration errors, spine movement after registration, patient body habitus, artifact from metallic implants, poor bone differentiation, skiving, soft-tissue interference, and physical constraints.
Despite the advancements of spine robot systems, several limitations persist, especially in mobile or unstable spine locations and around critical structures. The authors' experience, with provided case examples, further illustrates technical nuances important to understanding and navigating around these limitations. The need for standardized reporting metrics to evaluate and classify emerging technologies is highlighted, emphasizing ongoing technological innovation to enhance the efficacy of robot-assisted spine surgery.
随着脊柱外科机器人系统的发展，它们在不牺牲安全性或手术效率的情况下，展示了螺钉置入的高度准确性。这些机器人系统提供术前规划和实时反馈，以提高手术精度并降低人为错误。然而，它们的最佳性能仍存在限制。作者分析了在他们机构使用 Mazor X 机器人进行的最初 100 例椎弓根螺钉置入病例，通过病例示例说明了所经历的限制，并回顾了机器人辅助脊柱外科限制的当前文献，强调了它们对准确性和安全性的影响。
这是对作者机构在 2019 年 12 月至 2024 年 6 月期间进行的前 100 例机器人辅助椎弓根螺钉置入的回顾性研究。所有术中 CT 扫描均用于评估螺钉准确性。确定了位置不当的螺钉、险些失误（螺钉偏离而未损伤患者）或放弃机器人辅助尝试的情况，并评估了潜在原因，以确定当前机器人技术的限制。
在前 100 例机器人辅助椎弓根螺钉置入病例中，有 20 例与螺钉相关的并发症，其中 14 例为险些失误，1 例涉及因螺钉位置不当导致的神经损伤，5 例为在手动螺钉置入之前放弃机器人辅助尝试的病例。作者确定了当前机器人技术的以下限制：注册错误、注册后脊柱运动、患者体型、金属植入物的伪影、骨分化不良、削边、软组织干扰和物理限制。
尽管脊柱机器人系统取得了进步，但仍存在一些限制，尤其是在移动或不稳定的脊柱部位以及围绕关键结构时。作者的经验，通过提供的病例示例，进一步说明了理解和规避这些限制的重要技术细节。强调需要标准化的报告指标来评估和分类新兴技术，以强调持续的技术创新，从而提高机器人辅助脊柱外科的效果。
