Robot-Assisted Versus Fluoroscopy-Assisted Cortical Bone Trajectory Screw Instrumentation in Lumbar Spinal Surgery: A Matched-Cohort Comparison

Le, Xiao-Feng; Tian, Wei; Shi, Zhan; Han, Xiaoguang; Liu, Yajun; Liu, Bo; He, Da; Yuan, Qiang; Sun, Yin; Xu, Yu

doi:10.1016/j.wneu.2018.08.157

Cited by 100 publications

(92 citation statements)

References 23 publications

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“…There are several orthopaedic surgical robots that have been reported to be suitable for pedicle screw fixation, including the TiRobot, ROSA, SpineAssist, and Renaissance. Some studies have compared the robot‐assisted (RA) technique with the conventional technique, mainly focused on the intra‐pedicle accuracy of pedicle screws and radiation exposure. While some studies have compared the presence of FJV, to the best of our knowledge, no study has mentioned a specific FJV degree of these two techniques.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Superior‐Level Facet Joint Violations Between Robot‐Assisted Percutaneous Pedicle Screw Placement and Conventional Open Fluoroscopic‐Guided Pedicle Screw Placement

Zhang

Tian

et al. 2019

Orthopaedic Surgery

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Objective To compare the superior‐level facet joint violations (FJV) between robot‐assisted (RA) percutaneous pedicle screw placement and conventional open fluoroscopic‐guided (FG) pedicle screw placement in a prospective cohort study. Methods This was a prospective cohort study without randomization. One‐hundred patients scheduled to undergo RA (n = 50) or FG (n = 50) transforaminal lumbar interbody fusion were included from February 2016 to May 2018. The grade of FJV, the distance between pedicle screws and the corresponding proximal facet joint, and intra‐pedicle accuracy of the top screw were evaluated based on postoperative CT scan. Patient demographics, perioperative outcomes, and radiation exposure were recorded and compared. Perioperative outcomes include surgical time, intraoperative blood loss, postoperative length of stay, conversion, and revision surgeries. Results Of the 100 screws in the RA group, 4 violated the proximal facet joint, while 26 of 100 in the FG group had FJV (P = 0.000). In the RA group, 3 and 1 screws were classified as grade 1 and 2, respectively. Of the 26 FJV screws in the FG group, 17 screws were scored as grade 1, 6 screws were grade 2, and 3 screws were grade 3. Significantly more severe FJV were noted in the FG group than in the RA group (P = 0.000). There was a statistically significant difference between RA and FG for overall violation grade (0.05 vs 0.38, P = 0.000). The average distance of pedicle screws from facet joints in the RA group (4.16 ± 2.60 mm) was larger than that in the FG group (1.92 ± 1.55 mm; P = 0.000). For intra‐pedicle accuracy, the rate of perfect screw position was greater in the RA group than in the FG group (85% vs 71%; P = 0.017). No statistically significant difference was found between the clinically acceptable screws between groups (P = 0.279). The radiation dose was higher in the FG group (30.3 ± 11.3 vs 65.3 ± 28.3 μSv; P = 0.000). The operative time in the RA group was significantly longer (184.7 ± 54.3 vs 117.8 ± 36.9 min; P = 0.000). Conclusions Compared to the open FG technique, minimally invasive RA spine surgery was associated with fewer proximal facet joint violations, larger facet to screw distance, and higher intra‐pedicle accuracy.

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Section: Introductionmentioning

confidence: 99%

Comparison of Superior‐Level Facet Joint Violations Between Robot‐Assisted Percutaneous Pedicle Screw Placement and Conventional Open Fluoroscopic‐Guided Pedicle Screw Placement

Zhang

Tian

et al. 2019

Orthopaedic Surgery

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“…The TianJi Robot system with a robotic arm is not a "bone-mounted" robot and preoperative CT scans are not required because intraoperative images obtained by C-arm scanning are used for registration. A high level of accuracy for screw insertion and a reliable, safe process were demonstrated through the clinical use of the TianJi Robot system 18,19 . During our current study, we used the TianJi Robot system to assist in the transfacet screw insertion supplementing OLIF procedure.…”

Section: Introductionmentioning

confidence: 99%

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Yuan

Liu

et al. 2019

Orthopaedic Surgery

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Objectives Percutaneous transfacet screw fixation (pTSF) is a minimally invasive posterior fixation technique supplementing oblique lateral interbody fusion (OLIF) for lumbar spinal disorders. Accurate screw insertion is difficult to achieve and technically demanding under 2‐D fluoroscopy. Recently developed robot‐assisted spinal surgery demonstrated a high level of accuracy of pedicle screw insertion and a low complication rate. No published study has reported this combination technique. The aim of our study was to evaluate the accuracy and safety properties of the combination of both minimally invasive techniques: robot‐assisted pTSF supplementing the OLIF procedure. Methods This was an experimental and prospective study. Selected consecutive patients with lumbar degenerative disorders received robot‐assisted pTSF supplementing the OLIF procedure using the TianJi Robot system operated by one senior surgeon from March to October 2018. The accuracy of screw insertion and perioperative screw‐related complications were evaluated. Assessment of the accuracy of screw insertion included intraoperative robotic guidance accuracy and incidence of screw encroachments. Intraoperative robotic guidance accuracy referred to translational and angular deviations of screws, which were assessed by comparing the planned and actual screw trajectories guided by the robot on reconstructed images using TianJi Robot Planning Software. Screw encroachments were evaluated on postoperative CT images and classified by a grading system (A, excellent; B, good; C, poor). Screw‐related complications including intraoperative pin skidding, screw malposition and adjustment, together with postoperative neurological symptoms that correlated with screw malposition were recorded. Results Ten patients, with an average age of 60.2 years, were selected and recruited in this study. All cases were degenerative lumbar spinal disorders, out of which there were 6 cases of Meyerding Grade I degenerative spondylolisthesis. Twenty‐four transfacet screws were inserted by robotic assistance. Instrumented levels included nine segments at L 4–5 level and three segments at L 3–4 level. Two patients had both L 4–5 and L 3–4 level fixation. The average surgical time was 3.3 h (SD, 0.8 h). The mean blood loss was 90 mL (SD, 32 mL). Intraoperative guidance accuracy showed 1.09 ± 0.17 mm (ranging from 0.75 to 1.22 mm) translational deviation and 2.17° ± 0.39° (ranging from 1.47° to 2.54°) angular deviation. The gradings of screw encroachment were: 17 screws (71%) with Grade A, 6 screws (25%) with Grade B, and 1 screw (4%) with Grade C. Only one pin skidding occurred intraoperatively and revised subsequently. No postoperative neurological complications were found. Conclusion Our preliminary study of robot‐assisted pTSF supplementing the OLIF procedure showed a hig...

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“…Other Fluoroscopy time [14][15][16][20][21][22][23][25][26][27]30,32 Egger's test 0.00 0.999 False Radiation dose [13][14][15][16]19,20,22,25,26,30,32 Egger's test À 0.59 0.572 False Operative time [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]30,32 Egger's test 0.32 0.753 False Length of hospital stay 5,[12][13][14][15][16][20][21][22]32 Egger's test À 2.20 0.052 False Complication rate…”

Section: Limitationsmentioning

confidence: 99%

The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

Fang

Jin

et al. 2020

Robotics Computer Surgery

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Background: Medical robotics has enabled a significant advancement in the field of modern spine surgery, especially in pedicle screw fixation. A plethora of studies focused on the accuracy of pedicle fixation in robotic-assisted (RA) technology. However, it is not clear whether RA techniques can improve patients' clinical outcomes. Methods: We retrieved relevant studies that compare the differences between RA and freehand (FH) techniques in spine surgeries from the following databases: PubMed, Embase, Cochrane Library and Web of Science. The perioperative outcomes of this technology were measured with parameters including radiation exposure, operative time, the length of hospital stay, complication rates and revision rates. Two reviewers independently reviewed the studies in our sample, assessed their validity and extracted relevant data. Results: Our search resulted in a sample of 23 eligible studies, which involved 1247 patients (5042 pedicle screws) in the RA group and 1273 patients (4830 pedicle screws) in the FH group. With regard to the radiation exposure, the fluoroscopy time was less in surgeries assisted by Mazor robots (standard mean difference [SMD] ¼ À 0.96, 95% CI ¼ À 1.60 to À 0.31) but more in Tianji robots (SMD ¼ 0.91, 95% CI ¼ 0.17 to 1.66) and ROSA robots (SMD ¼ 2.57, 95% CI ¼ 2.01 to 3.13). For radiation dose, a decrease was observed in Tianji robots (SMD ¼ À 1.59, 95% CI ¼ À 2.13 to À 1.05). In the lumbar subgroup, the use of robots increased the operative time (SMD ¼ 0.53, 95% CI ¼ 0.19 to 0.86). In the degenerative diseases (DG) group, there was a significant decrease in the length of hospital stay when robots were introduced (SMD ¼ À 0.30, 95% CI ¼ À 0.48 to À 0.12). While in the DF (deformity) and DG group, a significant increase was found (SMD ¼ 0.17, 95% CI ¼ 0.02 to 0.32). The complication (OR ¼ 0.41, 95% CI ¼ 0.26 to 0.66) and the revision rates (OR ¼ 0.38, 95% CI ¼ 0.24 to 0.60) showed a significant decrease in the RA group compared to the conventional FH group. Conclusions: This study suggests that RA spine surgeries would result in fewer complications, a lower revision rate and shorter length of hospital stay. As the technology continues to evolve, we may expect more applications of robotic systems in spine surgeries. Junyu Li and Yanming Fang contributed equally to this work.

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Robot-Assisted Versus Fluoroscopy-Assisted Cortical Bone Trajectory Screw Instrumentation in Lumbar Spinal Surgery: A Matched-Cohort Comparison

Cited by 100 publications

References 23 publications

Comparison of Superior‐Level Facet Joint Violations Between Robot‐Assisted Percutaneous Pedicle Screw Placement and Conventional Open Fluoroscopic‐Guided Pedicle Screw Placement

Comparison of Superior‐Level Facet Joint Violations Between Robot‐Assisted Percutaneous Pedicle Screw Placement and Conventional Open Fluoroscopic‐Guided Pedicle Screw Placement

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

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