Background: Accurate pedicle screw placement is one of the fundamental surgical techniques for novice orthopedists in spinal oncology education. So, we set forth to establish a computer-assisted robotic navigation training program for spinal oncology education. Novice orthopedists and patients are involved in this study to evaluate the feasibility and safety of the computer-assisted robotic navigation (CARN) training program. Methods: In this research, 2 trainees were randomly taught by the CARN training program and the traditional training program. We prospectively collected clinical data from 1st May 2021 to 1st March 2022 in 45 patients with spinal tumors, including the time of PSP, serving as primary outcomes, the accuracy of the pedicle screw, and other clinical data. Then the ability of PSP was evaluated by cumulative sum (CUSUM) analysis, learning curve, and accuracy of pedicle screws. Results: The patients included in both groups had similar baseline characteristics. 169 pedicle screws in the CARN group and 179 pedicle screws in the traditional group were evaluated in our research. In the CUSUM analysis of the learning curve for the time of PSP, the turning point in the CARN group (70th pedicle screw) was less than the one in the traditional group (92nd pedicle screw). The LC-CUSUM test signaled competency for PSP at the 121st pedicle screw in the CARN group, while 138th in the traditional group. Then the accuracy of pedicle screws showed that the rate of grade A in the Gertzbein-Robbins classification was significantly higher in the CARN group than in the traditional group (88.17% and 79.55%, P=0.03 <0.05). Furthermore, no major complications occurred in both groups. Conclusion: We firstly described computer-assisted robotic navigation in spinal oncology education. We also indicated the CARN training program as a novel education method, and an efficient and safe surgical training program in spine surgery.

BackgroundEven if COVID-19 vaccine has gradually been adopted in the world, information of side effects and crosstalk in patients with spinal tumors is absent due to the exclusion from clinical research. In this research, we aimed to investigate the efficacy and safety for the patients with spinal tumors treated by denosumab.MethodsIn this retrospective research, 400 patients under treatment of denosumab against spinal tumors in real-clinical experience were grouped into two cohorts according to the treatment of COVID-19 vaccine. And linked hospital data, serum samples and unsolicited related adverse events had been collected from January 22nd 2021 to June 1st 2021 respectively.Results233 patients of all participants who received regular treatment of denosumab were vaccinated by mRNA or inactivated vaccine. Patients of metastatic disease and primary osseous spinal tumor showed similar distribution in both two groups. Over the study period, within 176 patients tested the status of serologic response of vaccine, 88(81.48%) and 41(87.23%) individuals injected one or two inactivated vaccines had effective antibody against SARS-CoV-2 infections. As 21 patients (85.71%) treated by mRNA vaccine did. Considering of the safety of vaccine, most common systemic adverse events were nausea or vomiting (45 events vs 23events). Interestingly, fewer participants in the vaccine group were statistically recorded in local adverse events than in the placebo group (16 events vs 33 events).ConclusionsOur initial real-clinical experience suggests that COVID-19 vaccines are likely safe and effective in in patients with spinal tumors receiving denosumab treatment.

ObjectiveThis study aims to highlight the use of robots in surgery and that of tube-assisted minimally invasive surgery for spinal metastases, as well as elaborate on the concept of invasion-controlled surgery (ICS).Summary of backgroundMany patients with spinal metastasis cancer cannot afford serious complications when undergoing traditional open surgery because of their poor physical condition. Robots and minimally invasive technology have been introduced into the field of spine surgery and they have shown significant advantages.MethodsSix patients who underwent robot and working tube-assisted ICS for spinal metastases. Relevant demographic, medical, surgical, and postoperative data were collected from medical records and analyzed.ResultsMean operative time was 3.8 h and the mean length of the surgical incision was 4.9 cm. The mean estimated blood loss was 400 ml. The mean bedtime and hospital length of stay were 3.2 days and 6.5 days, respectively. No obvious complications were reported during treatment. The mean accuracy of screw placement was 98%. The mean time for further system treatment after surgery was 5.8 days. All patients experienced significant pain relief. The mean preoperative visual analog scale (VAS) was 7.83 points. The mean VAS at 1 day, 1 week, and 1 month after surgery were 2.83, 1.83, and 1.17 points, respectively. Frankel grade was improved in five of six patients. One patient preoperatively with Frankel grade D was the same postoperatively.ConclusionThe concept of ICS is suitable for patients with spinal metastases. Robot and working tube-assisted ICS for spinal metastases is one of the safest and most effective treatment methods.