Wan Joseph Jon Yin, Tan Yong Yao, Ker Justin Rui Xin, Dinesh Shree Kumar
Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore.
Department of Neurosurgery, Changi General Hospital, Singapore, Singapore.
J Spine Surg. 2024 Dec 20;10(4):653-662. doi: 10.21037/jss-24-70. Epub 2024 Dec 17.
Robotic-assisted spinal surgery has reportedly improved the accuracy of instrumentation with smaller incisions, improving surgical outcomes and reducing hospital stay. However, robot-assisted spine surgery has thus far been confined to placement of pedicle screw instrumentation only. This pilot study aims to explore the feasibility of utilizing the Mazor™ X Stealth Edition (Medtronic, Sofamor Danek USA), robotic-arm platform in the minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) procedure inclusive of interbody cage placement, in our institution.
Single-centre, single surgeon prospectively collected case series of 29 patients who were planned for robot-assisted MIS-TLIF (RA-TLIF) with Mazor™ X Stealth system, on patient demographics [age, gender, body mass index (BMI), Charlson Comorbidity Index (CCI)], and post-operative outcomes.
Of the 29 RA-TLIF cases planned, 2 cases were excluded due to software start-up issues. One patient underwent revision surgery for posterior-migrated interbody cage. No loosening of posterior instrumentation was seen in all cases at 6 months follow-up.
Our single-institution pilot study on the Mazor™ X Stealth RA-TLIF has shown high pedicle screw insertion accuracy and relatively low complication rates, comparable to that of conventional MIS-TLIF O-arm navigation system. However, the discerning surgeon should be on the lookout for potential system-related pitfalls, as well as understand the limitations for robotic interbody cage placement. Further studies will also be required on patient outcomes and cost-effectiveness prior to consideration for wide scale implementation.
据报道，机器人辅助脊柱手术通过更小的切口提高了器械置入的准确性，改善了手术效果并缩短了住院时间。然而，迄今为止，机器人辅助脊柱手术仅限于椎弓根螺钉器械的置入。本前瞻性研究旨在探讨在我们机构中，使用Mazor™ X Stealth Edition（美敦力公司，美国索法莫丹尼克）机器人手臂平台进行包括椎间融合器置入的微创经椎间孔腰椎椎间融合术（MIS-TLIF）的可行性。
单中心、单术者前瞻性收集了29例计划采用Mazor™ X Stealth系统进行机器人辅助MIS-TLIF（RA-TLIF）患者的病例系列，记录患者人口统计学信息[年龄、性别、体重指数（BMI）、查尔森合并症指数（CCI）]及术后结果。
在计划的29例RA-TLIF病例中，2例因软件启动问题被排除。1例患者因椎间融合器向后移位接受了翻修手术。在6个月的随访中，所有病例均未发现后路器械松动。
我们关于Mazor™ X Stealth RA-TLIF的单机构前瞻性研究显示，椎弓根螺钉置入准确性高，并发症发生率相对较低，与传统MIS-TLIF O型臂导航系统相当。然而，经验丰富的外科医生应留意潜在的系统相关问题，并了解机器人辅助椎间融合器置入的局限性。在考虑广泛应用之前，还需要对患者预后和成本效益进行进一步研究。
