1Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and.
2Department of Medical Education, Lake Erie College of Medicine, Erie, Pennsylvania.
Neurosurg Focus. 2024 Dec 1;57(6):E11. doi: 10.3171/2024.9.FOCUS24489.
Robot-assisted (RA) technology is becoming more widely integrated and accepted in spine surgery. The authors sought to evaluate operative and patient-reported outcomes (PROs) in RA versus fluoroscopy-assisted (FA) pedicle screw placement during minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF).
The authors retrospectively studied elective patients who underwent single- or multilevel MIS TLIF for degenerative indication using FA versus RA pedicle screw placement. Patients were selected from September 2021 to May 2023 at a single institution with multiple surgeons whose practice consists of primarily MIS. Outcomes included fluoroscopy dosage per screw, operative time per screw, anesthesia time per screw, estimated blood loss (EBL), screw revision rate, inpatient surgical complications, and minimal clinically important difference (MCID) of Oswestry Disability Index (ODI) and numeric rating scale (NRS) scores at the 6- and 12-month follow-ups. Comparability of groups was analyzed by univariate analysis. Multivariable analysis modeling fluoroscopy time per screw was performed, adjusting for confounders.
One hundred eighty-three patients (n = 133 in the FA group vs 50 in the RA group) were included. Patients in the RA cohort were significantly younger than those in the FA group (mean age 63.8 ± 11.9 vs 59.8 ± 11.0 years, p = 0.037). A total of 932 pedicle screws were placed (mean 5.1, range 4-8 per patient). The RA cohort demonstrated significantly lower intraoperative fluoroscopy dosage per screw (4.9 ± 7.6 mGy per screw vs 20.3 ± 14.0 mGy per screw, p < 0.001), significantly longer anesthesia time per screw (49.1 ± 12.6 vs 43.6 ± 9.2, p = 0.009), and similar operative time per screw (33.3 vs 30.7 minutes, p = 0.125). The screw revision rate for symptomatic radiculopathy was zero in both groups. Revision surgery requiring screw removal or reposition was performed in 4 total cases (RA group: 1/50 for infection; FA group: 2/133 for infection, 1/133 for foraminotomy). Both groups demonstrated significant improvement in PROs at 6 and 12 months compared with preoperatively. Moreover, both groups achieved MCID at similar rates.
When implementing RA technology, one can expect similar perioperative outcomes as FA techniques in addition to significantly lower radiation exposure. Moreover, there is no statistically significant difference in postoperative PROs between RA and FA. Longer anesthesia times may also be encountered, as in this study, which is likely a result of more complex robotic setup and workflow.
机器人辅助（RA）技术在脊柱外科中越来越广泛地被整合和接受。作者旨在评估在微创经椎间孔腰椎体间融合术（TLIF）中，RA 与透视辅助（FA）椎弓根螺钉置入术治疗退行性疾病的手术和患者报告的结果（PRO）。
作者回顾性研究了 2021 年 9 月至 2023 年 5 月在一家单机构接受 FA 或 RA 椎弓根螺钉置入单节段或多节段微创 TLIF 治疗退行性疾病的择期患者。该机构的多位外科医生的手术主要为微创，选择了该机构的患者。结果包括每枚螺钉的透视剂量、每枚螺钉的手术时间、每枚螺钉的麻醉时间、估计失血量（EBL）、螺钉翻修率、住院手术并发症以及术后 6 个月和 12 个月 Oswestry 残疾指数（ODI）和数字评定量表（NRS）评分的最小临床重要差异（MCID）。使用单变量分析对两组进行可比性分析。对透视时间 per 螺钉进行了多变量分析建模，调整了混杂因素。
共纳入 183 例患者（FA 组 133 例，RA 组 50 例）。RA 组患者明显比 FA 组年轻（平均年龄 63.8 ± 11.9 岁 vs 59.8 ± 11.0 岁，p = 0.037）。共置入 932 枚椎弓根螺钉（平均 5.1 枚，每例患者 4-8 枚）。RA 组术中每枚螺钉的透视剂量明显较低（每枚螺钉 4.9 ± 7.6 mGy vs 每枚螺钉 20.3 ± 14.0 mGy，p < 0.001），每枚螺钉的麻醉时间明显较长（每枚螺钉 49.1 ± 12.6 分钟 vs 每枚螺钉 43.6 ± 9.2 分钟，p = 0.009），而每枚螺钉的手术时间相似（每枚螺钉 33.3 分钟 vs 每枚螺钉 30.7 分钟，p = 0.125）。两组症状性神经根病的螺钉翻修率均为零。共有 4 例（RA 组：1/50 例感染；FA 组：2/133 例感染，1/133 例椎间孔切开术）需要进行螺钉取出或重新定位的翻修手术。与术前相比，两组在术后 6 个月和 12 个月时 PRO 均有显著改善。此外，两组获得 MCID 的比例相似。
在实施 RA 技术时，除了明显降低辐射暴露外，还可以预期与 FA 技术类似的围手术期结果。此外，RA 和 FA 之间术后 PRO 没有统计学上的显著差异。在本研究中，还可能遇到较长的麻醉时间，这可能是由于机器人设置和工作流程更加复杂。
