Kazarian Gregory S, Groisser Benjamin N, Thakur Ankush, Dekhne Mihir S, Hillstrom Howard J, Kaidi Austin C, Mok Jung Kee, Adhiyaman Akshitha, Tracey Olivia C, Zucker Colson, Wisch Jenna L, Cunningham Matthew, Hresko M Timothy, Haddas Ram, Blanco John, Mintz Douglas N, Breighner Ryan E, Widmann Roger F, Heyer Jessica H
Hospital for Special Surgery, 535 E 70th St., New York, NY, 10021, USA.
Boston Children's Hospital, Boston, USA.
Spine Deform. 2025 Jul 21. doi: 10.1007/s43390-025-01150-8.
Cadaveric study.
Compare the accuracy and precision of robotic navigation (RAN), freehand (FH) and freehand navigation (NAV) techniques for pedicle screw placement.
Three cadavers were assigned to the FH, NAV, and RAN methods. Cadavers were CT scanned preoperatively, then underwent bilateral T1-L5 screw planning. RAN and NAV screws were placed by one surgeon, while the FH screws were placed by a second surgeon. Automated computer vision techniques were used to assess the tip, tail, and mid-pedicle screw positions compared to the preoperative plan along three axes on postoperative CT scans. Systematic error, precision, and accuracy were defined by signed mean error, two standard deviations (SDs), and mean absolute error (MAE), respectively. A factorial ANOVA with pairwise comparisons was used with post-hoc t-tests using Bonferroni corrections.
Eighty-seven screws were placed in three cadavers (24 RAN, 29 NAV, 34 FH). Fifteen screws were skipped due to registration difficulties (10 RAN, 5 NAV). RAN outperformed NAV and FH in regard to MAE angular deviation from planned screw trajectory (p < 0.001), the mid-pedicle in the superior-inferior direction (p = 0.002), and at the screw tip in all planes (p < 0.05), with a maximum error of 1.29 mm and 1.98° (vs. 2.29 mm and 5.23° for NAV and 5.67 mm and 11.18° for FH). No RAN screws had medial breach (1 (3.4%) for NAV; 4 (11.8%) for FH).
In our study, RAN demonstrated the best accuracy and precision in the majority of measured parameters, when compared to FH and NAV techniques.
尸体研究。
比较机器人导航（RAN）、徒手（FH）和徒手导航（NAV）技术在椎弓根螺钉置入中的准确性和精确性。
将三具尸体分配至FH、NAV和RAN方法组。术前对尸体进行CT扫描，然后进行双侧T1-L5螺钉规划。RAN和NAV螺钉由一名外科医生置入，而FH螺钉由另一名外科医生置入。术后CT扫描时，使用自动计算机视觉技术沿三个轴评估螺钉尖端、尾部和椎弓根中部位置与术前规划的对比情况。系统误差、精确性和准确性分别由符号平均误差、两个标准差（SD）和平均绝对误差（MAE）定义。采用析因方差分析及两两比较，并使用Bonferroni校正进行事后t检验。
在三具尸体中置入了87枚螺钉（24枚RAN、29枚NAV、34枚FH）。因配准困难跳过了15枚螺钉（10枚RAN、5枚NAV）。在MAE角度偏离计划螺钉轨迹方面（p < 0.001）、上下方向的椎弓根中部（p = 0.002）以及所有平面的螺钉尖端（p < 0.05），RAN的表现优于NAV和FH，最大误差为1.29毫米和1.98°（NAV为2.29毫米和5.23°，FH为5.67毫米和11.18°）。没有RAN螺钉出现内侧突破（NAV为1枚（3.4%）；FH为4枚（11.8%））。
在我们的研究中，与FH和NAV技术相比，RAN在大多数测量参数中表现出最佳的准确性和精确性。
