Robot-assisted orthopedic surgery in the treatment of adult degenerative scoliosis: a preliminary clinical report

Abstract

Study design A single-institution, retrospective cohort study. Objective To compare the accuracy and short-term clinical outcomes of pedicle screw placement between robot-assisted (RA) and freehand (FH) technique in the treatment of adult degenerative scoliosis (ADS). Methods From February 2018 to October 2019, 97 adult patients with degenerative scoliosis admitted to our department were retrospectively reviewed. Thirty-one patients received robot-assisted pedicle screw placement (RA group), and 66 patients underwent freehand pedicle screw placement (FH group). Patient demographics and short-term clinical outcomes were recorded and compared between two groups. Gertzbein-Robbins grading system was adopted to evaluate the accuracy of pedicle screw placement by means of postoperative CT scan. Short-term clinical outcomes consist of operative time, intraoperative blood loss, length of hospital stay (LOS), radiological parameters, Scoliosis Research Society-22 (SRS-22) scores before the operation, 6 months after operation, adverse events, and revisions. Results The accuracy of screw placement was higher than that of the FH group (clinically acceptable 98.7% vs. 92.2%; P < 0.001). Intraoperative blood loss of the RA group was less than those in the FH group (499 vs. 573 ml; P < 0.001). Operative time (283.1 vs. 291.9 min; P = 0.31) and length of stay (12.8 vs. 13.7 days; P = 0.36) were compared between RA and FH groups. In terms of radiological parameters, both of groups were improved postoperatively. The SRS-22 scores at 6 months after operation from both groups were better than those before operation. For surgery-related complication, one case had pressure sores in the RA group while two cases developed dural tears in the FH group. No revision was required in both groups. Conclusion Combined with other surgical correction modalities, robot-assisted pedicle screw fixation is an effective and safe method of treating degenerative scoliosis. Due to its satisfactory surgical outcomes such as higher accuracy and less trauma, it provides a good alternative for clinical practice. Level of evidence 3.

Robot-assisted minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a retrospective matched-control analysis for clinical and quality-of-life outcomes

“…The TiRobot system that we used was a multi-indication, real-time, image-guided orthopaedic surgical robot approved by China in 2016. So far, several literature have been published to evaluate the accuracy and clinical outcomes with utilization of orthopaedic robot in posterior cervical surgery and thoracolumbar surgery [14,[27][28][29]. At present, there is an increasing number of studies focusing on the combination of robot with MIS-TLIF technique in the treatment of lumbar degenerative disease [16][17][18][19]26,30].…”

Robot‐assisted technique vs conventional freehand technique in spine surgery: A meta‐analysis

“…From the present study, the robotic-assisted technique is independently related to much better outcomes compared with the conventional freehand technique in pedicle screw placement. 7,8,[17][18][19][20][21][22][23][24][25][26][27][28][29] These outcomes have vital effects on surgical practice. 7,8,[17][18][19][20][21][22][23][24][25][26][27][28][29] In summary, the data suggest a positive effect of the robotic-assisted technique on screw position grade A in Gertzbein-Robbins classification of the screw placement accuracy, postoperative stay, intraoperative blood loss, intraoperative radiation dose, and proximal facet violations in pedicle screw placement compared with conventional freehand technique.…”

Emerging Technologies in the Treatment of Adult Spinal Deformity

“…32 The growing clinical success of RGSS has in part driven the publication of additional studies in just the past year that utilizes robotics in spinal deformity-specific cases. Using clinical results from 2018-2019 for the correction of ASD, Chen et al 11 showed that RGSS (378 screws) improved blood loss (p < 0.001) and pedicle screw accuracy (p < 0.001) when compared to FH (786 screws). 11 Additionally, they showed that both RGSS and FH had comparable operative times (p = 0.31) and length of hospitalization (p = 0.36).…”

“…Using clinical results from 2018-2019 for the correction of ASD, Chen et al 11 showed that RGSS (378 screws) improved blood loss (p < 0.001) and pedicle screw accuracy (p < 0.001) when compared to FH (786 screws). 11 Additionally, they showed that both RGSS and FH had comparable operative times (p = 0.31) and length of hospitalization (p = 0.36). In 2020, Le et al 62 reported that RGSS (46 screws) resulted in less superior facet joint violation compared to FH (109 screws) (p = 0.04).…”

“…In spinal fusion surgery, RGSS has led to increased intraoperative accuracy for pedicle screw placement while decreasing radiation exposure, complication rates, operative time, blood loss and recovery time for patients. 11,12 Historically, surgeons relied on fluoroscopy-assisted free-hand screw placement, but many studies have now shown the superior accuracy that RGSS provides. 12 The ability of robotics to guide surgeon screw placement can yield fewer mistakes and reduce inter-surgeon variability.…”