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BACKGROUND: Traditional fluoroscopy-guided pedicle screw fixation is not highly accurate and can lead to serious surgical complications. To reduce surgical complications and improve the success rate of surgery, robotic assistive technology emerges as the times require. OBJECTIVE: To compare the difference of robot-assisted and fluoroscopy-guided pedicle screw placement using meta-analysis. METHODS: The study included clinical controlled trials on robot-assisted and fluoroscopy-guided pedicle screw placement published in and outside China from December 2008 to December 2018. The retrieval was performed in the online databases include Embase, PubMed, Central, CNKI, CQVIP, Wanfang, and CBM. Keywords used for search were robot assisted, fluoroscopy guided, conventional, freehand, pedicle screw in English and Chinese. After the data were extracted, statistical software Review Manager 5.3 was used for data-analysis. RESULTS AND CONCLUSION: (1) Based on the above search strategy, 1 615 studies were retrieved, and 13 were included. (2) Statistical analysis found that placement accuracy in the robot-assisted group was better than that of the fluoroscopy group [95%CI(1.55, 4.06), P=0.000 2]. Radiation intensity in the fluoroscopy group was lower than that in the robot-assisted group [95%CI(0.42, 0.82), P < 0.001], and the difference was statistically significant. (3) However, the incidence of complications [95%CI(0.23, 4.65), P=0.96] and revised surgery [95%CI(0.03, 3.17), P=0.33] were not statistically significant between the robot-assisted group and the fluoroscopy group. Intraoperative fluoroscopy time was similar between the two groups [95%CI(-38.55, 78.26), P=0.51]. Postoperative back pain [95%CI(-0.58, 0.38), P=0.68], leg pain score [95%CI(-0.20, 0.19), P=0.94] and operation time [95%CI(-6.33, 53.02), P=0.12] were also similar between the two groups, and the differences were not statistically significant. (4) Compared with fluoroscopy, robot-assisted technique has higher pedicle screw placement accuracy, especially under percutaneous conditions. Inevitably, the intraoperative radiation intensity is also more than conventional fluoroscopy.
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BACKGROUND: Computer navigation system and orthopedic surgery robot have been developed rapidly in spine surgery in recent years, but the operation effect of computer navigation or navigation robot is still questioned. OBJECTIVE: To compare the difference in robot-assisted and fluoroscopy-guided pedicle screw placement. METHODS: The study included clinical trials published in and outside China from August 2008 to August 2019. The retrieval was performed in the online databases including Embase, PubMed, CNKI, and Wanfang Data. Key words in Chinese were: robot assisted, fluoroscopy guided, pedicle screw, pedicle nail, pedicle screw rod, pedicle internal fixation. Search strategy was: pedicle screw AND robot assisted OR fluoroscopy guided. Key words in English were: Robot assisted, Fluoroscopy guided, Pedicle screw, Pedicle stick, Pedicle screw fixation. Search strategy was: “Pedicle screw” OR “Pedicle stick” OR “Pedicle screw fixation” AND “Fluoroscopy guided” OR “Robot assisted”. After data extraction, statistical software Review Manager 5.3 was used for data analysis. RESULTS AND CONCLUSION: (1) Based on the above search strategy, 357 studies were retrieved. A total of 19 trials were included, containing 17 English studies and 2 Chinese studies. (2) Meta-analysis results displayed that the accuracy of placement of the robot-assisted group was superior to that of the fluoroscopy-guided group [95%CI(1.82, 2.52), P < 0.001]. Number of surgical complications [95%CI(0.25, 0.69), P=0.0006] and revision number [95%CI(0.23, 0.71), P=0.002] were less in the robot-assisted group than in the fluoroscopy-guided group. (3) When evaluating pedicle screw placement, robot-assisted has higher pedicle screw placement accuracy, fewer complications and fewer revisions, and is superior to traditional fluoroscopy-guided technique in accuracy and safety. Considering the expensive price and complex operation steps of navigation robot technology, the selection of specific nail placement method should still follow the principle of individualized treatment.
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Objective To discuss the clinical application of percutaneous radiologic gastrostomy (PRG) in treating dysphagia associated with amyotrophic lateral sclerosis (ALS),and to evaluate its safety and improvement effect on patient's nutritional status in ALS patients with pulmonary insufficiency.Methods The clinical data of 51 ALS patients who received PRG were retrospectively analyzed.The success rate of surgery and postoperative complications were recorded.All patients were regularly followed up,and the longterm complications as well as the one-,3-and 6-month mortality rates after the surgery were documented.The improvement of patient's nutritional status was evaluated.Results PRG was successfully accomplished in all 51 patients,the technical success rate was 100％.Mild postoperative complications occurred in 7 patients (13.73％) and severe massive hemorrhage in one patient (2.0％).After PRG,no signs or symptoms of impaired respiratory function were observed.No death occurred in one month and in 3 months after PRG.Six months after PRG,three patients died(6.8 ％,3/44).One month after PRG,31 patients had an increase in body weight of more than 1 kg,and the mean BMI was increased from preoperative t8.60±2.14 to postoperative 19.27±1.81 (one month after PRG),19.17±1.93 (3 month after PRG) and 18.89±2.33 (6 month after PRG).Conclusion For the performance of PRG no gastroscopy or anesthesia is needed,thus,the risk of aspiration asphyxia can be reduced in ALS patients complicated by pulmonary insufficiency and the success rate as well as the safety can be improved.Therefore,this technique is an effective means to ensure that the ALS patients with pulmonary insufficiency can get adequate energy intake to improve their nutritional status.
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Sacroiliitis, a condition commonly seen in ankylosing spondylitis, is well known to be one of the main pain generators of low back pain, which may result in difficulty with walking. A 20-year old male with history of ankylosing spondylitis presented to the University Hospital of the West Indies, Physical Medicine and Rehabilitation Clinic, with a two-year history of right buttock, low back and groin pain. Radiographic evaluation revealed increased sclerosis and erosive changes in bilateral sacroiliac joints, right greater than left. Right intra-articular sacroiliac joint steroid injection was administered under fluoroscopy guidance. Post-injection visual analogue pain scale (VAS) score with activity improved from 8 to 1 and Oswestry Disability Index improved from 40% moderate disability to 16% minimal disability. The patient's overall assessment was 95% perceived improvement in pain. This case report illustrates the effectiveness of intra-articular sacroiliac joint steroid injection in treating sacroiliitis in ankylosing spondylitis.
La sacroilitis, una condición comúnmente vista en la espondilitis anquilosante, es bien conocida por ser uno de los principales generadores de dolor lumbar, que puede ocasionar dificultad para caminar. Un paciente de 20 años de edad con una historia de espondilitis anquilosante, acompañada de dos años de dolor en la nalga derecha, la región lumbar, y en la ingle, acudió a la Clínica de Rehabilitación y Medicina Física del Hospital Universitario de West Indies. La evaluación radiográfica reveló esclerosis aumentada y cambios erosivos en la articulación sacroilíaca bilateral, mayor en el lado derecho que en el izquierdo. Con la ayuda de la fluoroscopia para guiar el procedimiento, se le administró al paciente una inyección intraarticular de esteroide en la articulación sacro-ilíaca, al lado derecho. La puntuación de la escala analógica visual del dolor (VAS) tras la inyección mejoró de 8 a 1, y el Índice de Discapacidad de Oswestry mejoró de una discapacidad moderada del 40% a una mínima discapacidad del 16%. La evaluación general del paciente fue de un 95% en cuanto a la percepción de la mejoría del dolor. Este reporte de caso ilustra la eficacia de la inyección intraarticular de esteroides de la articulación sacroilíaca para el tratamiento de la sacroiliitis en la espondilitis anquilosante.
Subject(s)
Humans , Male , Young Adult , Spondylitis, Ankylosing/drug therapy , Fluoroscopy/methods , Sacroiliitis/drug therapy , Spondylitis, Ankylosing/complications , Steroids/administration & dosage , Treatment Outcome , Sacroiliitis/etiology , Injections, Intra-Articular/methodsABSTRACT
Conventional transcrural CPB via the "walking off" the vertebra technique may injure vital organs while attempting to proximally spread injectate around the celiac plexus. Therefore, we attempted the CT-simulated fluoroscopy-guided transdiscal approach to carry out transcrural CPB in a safer manner, spreading the injectate more completely and closely within the celiac plexus area. A 54-year-old male patient with pancreatic cancer suffered from severe epigastric pain. The conventional transcrural approach was simulated, but the needle pathway was impeded by the kidney on the right side and by the aorta on the left side. After simulating the transdiscal pathway through the T11-12 intervertebral disc, we predetermined the optimal insertion point (3.6 cm from the midline), insertion angle (18 degrees), and advancement plane, as well as the proper depth. With the transdiscal approach, we successfully performed transcrural CPB within a narrow angle, and the bilateral approach was not necessary as we were able to achieve the bilateral spread of the injectate with the single approach.
Subject(s)
Humans , Male , Middle Aged , Aorta , Celiac Plexus , Intervertebral Disc , Kidney , Needles , Pancreatic Neoplasms , SpineABSTRACT
BACKGROUND: Cervical radicular pain can arise fromvarious structures, including spinal nerves, discs, zygapophyseal joints, ligaments, and myofascial connective tissue. However, no adequate experiments have been found regarding methods for the microadhesiolysis of adhesional connective tissue around the zygapophyseal joints and nerves. The first objective of this study was to ascertain the effect of fluoroscopy guided interventional microadhesiolysis and nerve stimulation (FIMS) on chronic cervical radicular pain caused by zygapophyseal joint dysfunction. The second objective was to identify the duration of pain alleviation, as well as commonly occurring regions for zygapophyseal joint dysfunction. METHODS: Twenty-eight patients were diagnosed with cervical radicular pain. The cervical zygapophyseal joints and adhesional structures around the cervical zygapophyseal joints were stimulated by adhesiolysis with a rounded needle; the procedure was performed once every second week. A visual analogue scale (VAS) for pain and neck range of motion (ROM) were used as indices for evaluating the degree of pain 1 and 3 months after completion of the procedures. A relief effect of FIMS was accepted when the VAS index decreased 50% compared with a previous VAS, and when there was absence of limitation of ROM. RESULTS: Among the patients, 52% showed zygapophyseal joint dysfunction in C5-6, 38% in C4-5, 7% in C2-3, and 3% in C6-7. After performing FIMS, the VAS index decreased in most of the patients after 1 and 3 months (92.8% and 75%, respectively), and treatment frequency was 2.7 +/- 1.2. There was no correlation between the number of FIMS procedures and the degree of VAS. CONCLUSIONS: FIMS is considered an effective modality in patients suffering from cervical radicular pain.