Predictors of accurate intrapedicular screw placement in single-level lumbar (L4-5) fusion: robot-assisted pedicle screw, traditional pedicle screw, and cortical bone trajectory screw insertion

Abstract

Background The superiorities in proximal facet joint protection of robot-assisted (RA) pedicle screw placement and screw implantation via the cortical bone trajectory (CBT) have rarely been compared. Moreover, findings on the screw accuracy of both techniques are inconsistent. Therefore, we analyzed the screw accuracy and incidence of facet joint violation (FJV) of RA and CBT screw insertion in the same study and compared them with those of conventional pedicle screw (PS) insertion. The possible factors affecting screw accuracy and FJV were also analyzed. Methods A total of 166 patients with lumbar degenerative diseases requiring posterior L4-5 fusion were retrospectively included and divided into the RA, PS, and CBT groups from March 2019 to December 2021. The grades of intrapedicular accuracy and superior FJV were evaluated according to the Gertzbin–Robbins scale and the Babu scale based on postoperative CT. Univariable and multivariable analyses were conducted to assess the possible risk factors associated with intrapedicular accuracy and superior FJV. Results The rates of optimal screw insertion in the RA, PS, and CBT groups were 87.3%, 81.3%, and 76.5%, respectively. The difference between the RA and CBT groups was statistically significant (P = 0.004). Superior FJVs occurred in 28.2% of screws in RA, 45.0% in PS, and 21.6% in CBT. The RA and CBT groups had fewer superior FJVs than the PS group (P = 0.008 and P < 0.001, respectively), and no significant difference was observed between the RA and CBT groups (P = 0.267). Multivariable analysis revealed that the CBT technique was an independent risk factor for intrapedicular accuracy. Furthermore, older age, the conventional PS technique and a smaller facet angle were independently associated with the incidence of superior FJVs. Conclusions The RA and CBT techniques were associated with fewer proximal FJVs than the PS technique. The RA technique showed a higher rate of intrapedicular accuracy than the CBT technique. The CBT technique was independently associated with screw inaccuracy. Older age, conventional PS technique and coronal orientation of the facet join were independent risk factors for superior FJV.

Risk factor analysis of the accuracy and safety of planned and actual screw paths with robot-assisted technology

“…Previous literature reported the same clinical results in xation with CBT screws compared to pedicle screwing. 23 In a study on transforaminal lumbar fusion, similar fusion rates and accuracy were obtained with CBT and pedicle screws. 5 In our opinion, CBT screws have little soft tissue between the sleeve and the bone of vertebral plate due to midline exposure, resulting in less soft tissue traction and obstruction that can interfere with screw accuracy.…”

The effect of the cortical bone trajectory screw fixation and traditional pedicle screw fixation on surgical site wound infection in posterior lumbar fusion wound: A meta‐analysis

“…In investigations that were considered for the meta-analysis, 1195 individuals with PLF were in the chosen investigations' starting point, 578 of them were using CBTSF, and 617 were using TPSF. [12][13][14][15][16][17][18][19][20][21][22][23][24] No significant difference was found between individuals using CBTSF and TPSF in SSWI, superficial SSWI, and deep SSWI in PLF. Though precautions must be exercised when dealing with its values since some of the selected investigations for this meta-analysis were with a low sample size (8 out of 13 were ≤100 individuals) and a low number of selected investigations for some parameters studied.…”

“…13 publications, published between 2015 and 2023, from a total of 1657 connected investigations that met the inclusion criteria were chosen and included in the investigation. [12][13][14][15][16][17][18][19][20][21][22][23][24] The results of these researches are presented in Table 2. 1195 individuals with PLF were in the chosen investigations' starting point, 578 of them were using CBTSF, and 617 were using TPSF.…”

“…13 publications, published between 2015 and 2023, from a total of 1657 connected investigations that met the inclusion criteria were chosen and included in the investigation 12‐24 . The results of these researches are presented in Table 2.…”

Accuracy and Screw Insertion Time of Robotic-Assisted Cortical Bone Trajectory Screw Placement for Posterior Lumbar Interbody Fusion: A Comparison of Early, Middle, and Late Phases

“…Due to the difference from the traditional PS trajectory, computer-assisted devices such as navigation [4][5][6][7] and three-dimensional (3D)-printed templates [8][9][10][11] are being used. Furthermore, recently, robotic-assisted spine surgery has been performed, which is expected to contribute to improving the safety of the CBT screw [12][13][14][15][16].…”