Russo Fabrizio, Nardi Niccolò, Papalia Giuseppe Francesco, Papalia Rocco, Vadalà Gianluca, Denaro Vincenzo
Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128, Roma, Italy.
Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128, Roma, Italy.
Eur Spine J. 2025 May;34(5):1890-1899. doi: 10.1007/s00586-025-08822-z. Epub 2025 Apr 9.
Image-guided navigation and robotic systems have been introduced in spinal surgery to increase the accuracy of pedicle screws placement and reduce the rate of complications. The objective of this study is to evaluate the different final screw deviation from pre-operative planning and the associated pedicle screw accuracy in spinal fusion surgery assisted by image-guided navigation or robotic systems.
The systematic literature search was executed using PubMed-Medline, Cochrane Central, and Scopus on 30 April 2023. Studies that explored the deviation between final position and preoperative planning of pedicle screws assisted by image-guide navigation or robotic system were included. The data extracted were surgical approach, surgical aid, number of screws evaluated, spinal levels, accuracy and deviation of screws. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) or the methodological index for non-randomized studies (MINORS) score.
This review included 15 studies, of which 5 used navigation and 10 robotic system. The studies involved 1487 patients, with the evaluation of a total of 7274 pedicle screws, with an assessment of planning and final position. The different methodologies to calculate the deviation include angular deviations in the axial and sagittal plane, 3D angular deviation, and tip and entry point deviation. Regarding screw accuracy, 98.15% of the screws were grade A or B, and 1.85% as category C or D.
Although preoperative planning allows the surgeon to plan the final position of the screw most appropriately, mild deviations from it do not seem to excessively influence the accuracy of the spinal fusion.
脊柱手术中引入了图像引导导航和机器人系统，以提高椎弓根螺钉置入的准确性并降低并发症发生率。本研究的目的是评估在图像引导导航或机器人系统辅助的脊柱融合手术中，最终螺钉与术前规划的不同偏差以及相关的椎弓根螺钉准确性。
于2023年4月30日使用PubMed-Medline、Cochrane Central和Scopus进行系统文献检索。纳入探讨图像引导导航或机器人系统辅助下椎弓根螺钉最终位置与术前规划之间偏差的研究。提取的数据包括手术入路、手术辅助工具、评估的螺钉数量、脊柱节段、螺钉的准确性和偏差。使用修订后的Cochrane随机试验偏倚风险工具（RoB 2）或非随机研究方法学指数（MINORS）评分评估研究质量。
本综述纳入15项研究，其中5项使用导航，10项使用机器人系统。这些研究涉及1487例患者，共评估7274枚椎弓根螺钉，并对规划和最终位置进行了评估。计算偏差的不同方法包括轴向和矢状面的角度偏差、三维角度偏差以及尖端和入口点偏差。关于螺钉准确性，98.15%的螺钉为A级或B级，1.85%为C级或D级。
虽然术前规划能让外科医生最恰当地规划螺钉的最终位置，但与之存在的轻微偏差似乎并不会过度影响脊柱融合的准确性。
