Birch Craig, Welch Nicole, Cook Danielle, Hedequist Daniel
Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
Harvard Medical School, Boston, MA, USA.
Spine Deform. 2025 Feb 1. doi: 10.1007/s43390-025-01047-6.
This technical report presents the intraoperative experience of using robotic-assisted navigation (RAN) for sacropelvic instrumentation in pediatric spine deformity surgery.
A retrospective review of patients who underwent surgery using RAN for sacropelvic instrumentation at a single institution from 2019 to 2022 was conducted. In cases with screw confirmation imaging, screws were evaluated using the Gertzbein and Robbins classification scale.
52 cases were included. Average age at surgery was 14.1 years and 67.3% of patients were female. The most common diagnosis was spondylolisthesis (48.1%). The average major curve in scoliosis cases was 77°. A Schanz pin in the posterior superior iliac spine was placed in 98.1% of surgeries compared to 1 case with a spinous process clamp. Intraoperative 3D imaging scans (Scan & Plan) were used for 69.2% of the robotic registrations to the patient and intraoperative fluoroscopy-CT scans were used for 30.8%. 644 total screws were placed, with 427 placed robotically. Specifically, in the sacral-pelvic region, 98 S1, 18 S2, 58 S2AI, and 5 iliac screws were placed using RAN (179 screws). In 17 cases with 139 total robotic screws, post-instrumentation intraoperative 3D imaging or postoperative CT scans were obtained. Of these screws, 99.3% (138/139; 95% CI = 95.5-99.96) were placed accurately (Grade A or Grade B). One S2AI screw had an anterior breach on intraoperative 3D imaging scan and was changed prior to closure. Loss of RAN registration was observed in 2 cases (3.8%). No cases required return to the operating room for screw malposition.
This study highlights high screw accuracy with no neurologic compromise associated with the use of RAN technology.
本技术报告介绍了在小儿脊柱畸形手术中使用机器人辅助导航（RAN）进行骶骨盆器械置入的术中经验。
对2019年至2022年在单一机构接受使用RAN进行骶骨盆器械置入手术的患者进行回顾性研究。在有螺钉确认成像的病例中，使用格茨贝恩和罗宾斯分类量表对螺钉进行评估。
纳入52例病例。手术时的平均年龄为14.1岁，67.3%的患者为女性。最常见的诊断是腰椎滑脱（48.1%）。脊柱侧弯病例的平均主弯为77°。98.1%的手术在髂后上棘置入了斯氏针，1例使用了棘突夹。69.2%的机器人与患者配准使用了术中三维成像扫描（扫描与计划），30.8%使用了术中透视-CT扫描。共置入644枚螺钉，其中427枚通过机器人置入。具体而言，在骶骨盆区域，使用RAN置入了98枚S1螺钉、18枚S2螺钉、58枚S2AI螺钉和5枚髂骨螺钉（共179枚螺钉）。在17例共置入139枚机器人螺钉的病例中，术后获得了器械置入后的术中三维成像或术后CT扫描。在这些螺钉中，99.3%（138/139；95%CI=95.5-99.96）置入准确（A级或B级）。1枚S2AI螺钉在术中三维成像扫描时有前方突破，在关闭切口前更换。2例（3.8%）观察到RAN配准丢失。没有病例因螺钉位置不当需要返回手术室。
本研究强调了使用RAN技术时螺钉置入准确率高且无神经损伤。
