Vengsarkar Ved A, Goudarzi Ariaz, Chi Jialun, Yassa Arsany, Wang Jesse, Labaran Lawal, Li Xudong
Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Department of Orthopaedic Surgery, University of Virginia School of Medicine, 2280 Ivy Rd, Charlottesville, VA, 22903, USA.
J Robot Surg. 2025 Jul 11;19(1):375. doi: 10.1007/s11701-025-02543-7.
Adult spinal deformity (ASD) represents a challenging area in spinal surgery due to its complexity and potential for postoperative complications. While robotic systems have promised enhanced precision for pedicle screw placement, improved alignment, and potentially fewer complications, the comparative efficacy and morbidity of robotic-assisted (RA) versus free-hand (FH) techniques remains underexplored in the context of ASD. This study aims to compare postoperative outcomes in patients undergoing RA techniques versus FH surgery to manage ASD. A retrospective review was performed and included patients over 18 who underwent a posterior fusion of at least 7 segments from 2015 to 2022. Two separate cohorts were created based on the use of RA or FH. Patients were matched with a 1:5 ratio based on age, sex, utilization of posterior column osteotomy, utilization of three-column osteotomy, utilization of pelvic fixation, number of instrumented levels, and prior lumbar revision. Multivariate logistic regression was used to compare 90-day complications and healthcare utilization. The RA group demonstrated a significantly lower incidence of atelectasis (3.0% vs. 6.8%; p=0.018), respiratory failure (2.7% vs. 6.7%; p = 0.010), pleural effusion (3.3% vs. 7.0%; p = 0.021), and pneumonia (2.1% vs. 6.0%; p = 0.004) compared to the FH group. In addition, the RA group also demonstrated a reduced incidence of spinal cord deficits (1.2% vs. 3.4%; p = 0.048) and a shorter average length of stay (LOS), in days (8.1 +/- 8.3 vs. 10.2 +/- 12.8; p = 0.009). In the present study, we discover that robotic assistance leads to improved short-term outcomes, including reduced rates of pulmonary (atelectasis, pneumonia, pleural effusion, respiratory failure) and neurologic (spinal cord deficit) complications, as well as shorter hospital stays. While RA systems have previously demonstrated technical advantages in pedicle screw placement, this study provides evidence of meaningful clinical benefits as well.
成人脊柱畸形（ASD）因其复杂性和术后并发症的可能性，在脊柱外科领域是一个具有挑战性的领域。虽然机器人系统有望提高椎弓根螺钉置入的精度、改善对线，并可能减少并发症，但在ASD背景下，机器人辅助（RA）技术与徒手（FH）技术的相对疗效和发病率仍未得到充分研究。本研究旨在比较接受RA技术与FH手术治疗ASD患者的术后结果。进行了一项回顾性研究，纳入了2015年至2022年期间接受至少7节段后路融合术的18岁以上患者。根据是否使用RA或FH创建了两个独立的队列。根据年龄、性别、后柱截骨术的使用情况、三柱截骨术的使用情况、骨盆固定的使用情况、器械固定节段数和既往腰椎翻修情况，以1:5的比例对患者进行匹配。使用多变量逻辑回归比较90天并发症和医疗资源利用情况。与FH组相比，RA组肺不张（3.0%对6.8%；p = 0.018）、呼吸衰竭（2.7%对6.7%；p = 0.010）、胸腔积液（3.3%对7.0%；p = 0.021）和肺炎（2.1%对6.0%；p = 0.004）的发生率显著降低。此外，RA组脊髓损伤的发生率也有所降低（1.2%对3.4%；p = 0.048），平均住院天数缩短（8.1±8.3天对10.2±12.8天；p = 0.009）。在本研究中，我们发现机器人辅助可改善短期结果，包括降低肺部（肺不张、肺炎、胸腔积液、呼吸衰竭）和神经（脊髓损伤）并发症的发生率，以及缩短住院时间。虽然RA系统此前已在椎弓根螺钉置入方面显示出技术优势，但本研究也提供了有意义的临床益处的证据。
