Zheng Wenjie, Wu Junlong, Xia Wen, Zuo Rui, Chang Xian, Yin Hong, Li Changqing, Zhang Chao
Department of Orthopaedics, Xinqiao Hospital of Army Medical University, Chongqing, People's Republic of China.
Department of Orthopaedics, The 941th Hospital of Joint Logistic Support Force of Chinese People Liberation Army, Xining, Qinghai, People's Republic of China.
J Pain Res. 2025 Aug 25;18:4361-4371. doi: 10.2147/JPR.S540581. eCollection 2025.
The spinal surgery robot can provide precise preoperative or intraoperative surgical planning and guide the implementation of the surgical plan under real-time navigation monitoring. Researchers have recently begun exploring the use of robotic systems to assist in performing Percutaneous Endoscopic Lumbar Discectomy (PELD). However, prior studies have primarily focused on robotic-assisted transforaminal puncture. In this study, we establish a two-step cannulation surgical workflow using specialized instruments to facilitate the whole-process robotic-assisted PELD.
In this study, 14 patients with lumbar disc herniations were enrolled to undergo PELD assisted by a robotic system. Preoperative CT images were registered in the navigation system for surgical planning. The whole procedure was performed under spinal robotic guidance, including puncture, dilation, foraminoplasty, and working tube placement. A retrospective analysis was conducted to evaluate its feasibility and safety, as well as to summarize the surgical workflow.
All patients successfully completed the robotic-assisted PELD surgery. The average robot preparation time was 31.42±6.45 minutes, the cannula placement time was 9.85±2.59 minutes, and the mean operative time was 92.21±18.65 minutes. The average number of intraoperative fluoroscopy shots was 3.35±0.84. Postoperative follow-up showed significant improvement in back pain/leg pain VAS scores and ODI scores compared with preoperative values. According to the modified Macnab criteria, 8 cases were rated as excellent (57.1%), and 6 cases as good (42.9%), resulting in an overall satisfaction rate of 100%. No patients experienced severe complications such as nerve root injury or deep infection.
Robotic assistance in PELD surgery ensures a precise preoperative planning and safe implementation, also reducing radiation exposure both patients and surgeons. With specialized instruments, the two-step access method simplifies PELD as a safe and effective surgery.
脊柱手术机器人能够提供精确的术前或术中手术规划，并在实时导航监测下指导手术计划的实施。研究人员最近开始探索使用机器人系统辅助进行经皮内窥镜腰椎间盘切除术（PELD）。然而，先前的研究主要集中在机器人辅助经椎间孔穿刺。在本研究中，我们使用专门器械建立了两步置管手术工作流程，以促进全过程机器人辅助PELD。
本研究纳入14例腰椎间盘突出症患者，接受机器人系统辅助的PELD手术。术前CT图像在导航系统中进行配准以进行手术规划。整个手术过程在脊柱机器人引导下进行，包括穿刺、扩张、椎间孔成形术和工作通道放置。进行回顾性分析以评估其可行性和安全性，并总结手术工作流程。
所有患者均成功完成机器人辅助PELD手术。机器人准备平均时间为31.42±6.45分钟，套管放置时间为9.85±2.59分钟，平均手术时间为92.21±18.65分钟。术中平均透视次数为3.35±0.84次。术后随访显示，与术前相比，背痛/腿痛视觉模拟评分（VAS）和腰椎功能障碍指数（ODI）评分有显著改善。根据改良Macnab标准，8例评为优（57.1%），6例评为良（42.9%），总体满意率为100%。无患者发生神经根损伤或深部感染等严重并发症。
机器人辅助PELD手术可确保精确的术前规划和安全实施，同时减少患者和术者的辐射暴露。通过专门器械，两步入路法简化了PELD手术，使其成为一种安全有效的手术。
