1Department of Neurosurgery, Shuang-Ho Hospital, Taipei Medical University, New Taipei City.
2Taipei Neuroscience Institute, Taipei Medical University, Taipei.
Neurosurg Focus. 2024 Dec 1;57(6):E12. doi: 10.3171/2024.9.FOCUS24521.
Both robot and computer navigation have significantly improved the accuracy and safety of percutaneous pedicle screw placement compared with a freehand fluoroscopy-guided technique. However, how the two new technologies compare with each other is unknown. The aim of this study was to investigate the accuracy and safety of robot-assisted and navigation-guided percutaneous pedicle screw placement in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
A multicenter, retrospective study was conducted with patients who underwent 1- to 3-level MIS-TLIF from 2019 to 2022. The surgical indication was symptomatic spinal stenosis and spondylolisthesis that failed conservative management. Screw accuracy and safety were compared between robot and computer navigation systems by obtaining postoperative CT images in all patients. The screw accuracy was determined by the Gertzbein and Robbins classification.
A total of 100 patients were divided into robot-assisted (RA; n = 42) and O-arm navigation (ON; n = 58) groups, with 514 percutaneous pedicle screws placed. Clinically satisfactory accuracy was achieved in 100% of the RA group and 92.1% of the ON group (p < 0.001). There were no medial breaches or revision surgeries for screw malposition in either group. The RA group showed similar overall operation time to the ON group (263.54 ± 114.33 vs 243.4 ± 68.96 minutes, p = 0.2821). Subgroup analyses showed that there was no difference in 1-level MIS-TLIF, but the RA group had significantly more operative time for 2-level MIS-TLIF than the ON group (324.67 ± 101.25 vs 266.4 ± 66.38 minutes, p = 0.0264).
Screw accuracy was significantly better in the RA group, with slightly more operation time, compared with the navigation group. Neither group required revision surgery or reoperation for screw malposition.
与徒手透视引导技术相比，机器人和计算机导航显著提高了经皮椎弓根螺钉置入的准确性和安全性。然而，这两种新技术相互之间如何比较尚不清楚。本研究旨在探讨机器人辅助和导航引导经皮椎弓根螺钉置入在微创经椎间孔腰椎体间融合术（MIS-TLIF）中的准确性和安全性。
这是一项多中心、回顾性研究，纳入了 2019 年至 2022 年间接受 1-3 个节段微创经椎间孔腰椎体间融合术（MIS-TLIF）的患者。手术指征为症状性脊柱狭窄和保守治疗失败的滑脱。所有患者均获得术后 CT 图像，比较机器人和计算机导航系统的螺钉准确性和安全性。螺钉准确性采用 Gertzbein 和 Robbins 分类法确定。
共纳入 100 例患者，分为机器人辅助（RA；n=42）和 O 臂导航（ON；n=58）组，共置入 514 枚经皮椎弓根螺钉。RA 组临床满意度达到 100%，ON 组为 92.1%（p＜0.001）。两组均无螺钉位置不良的内侧突破或翻修手术。RA 组的总手术时间与 ON 组相似（263.54±114.33 与 243.4±68.96 分钟，p=0.2821）。亚组分析显示，1 节段 MIS-TLIF 时两组无差异，但 2 节段 MIS-TLIF 时 RA 组的手术时间明显长于 ON 组（324.67±101.25 与 266.4±66.38 分钟，p=0.0264）。
与导航组相比，RA 组螺钉准确性显著提高，手术时间略长。两组均无需因螺钉位置不良而进行翻修手术或再次手术。
