ABSTRACT
【Objective】 To compare the clinical effects and screw placement accuracy for treating lumbar disc herniation between robot-assisted minimal invasive transforaminal lumbar interbody fusion (RA-MIS-TLIF) and minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF). 【Methods】 We retrospectively recruited 69 patients with single segment lumbar disc herniation treated between January 2018 and August 2019 at Honghui Hospital of Xi’an Jiaotong University. There were cases of 33 RA-MIS-TLIF (RA group) and 36 MIS-TLIF (MIS-TLIF group). Subsequently, the patients’ baseline characteristics were collected, including age, gender, body mass index, complication with diabetes, duration of symptoms, operated segment, and follow-up time. We also collected perioperative parameters such as operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, screw placement accuracy, wound drainage, hospitalization duration, postoperative complicatins, and fusion rate. Lower back pain, lower extremity pain visual analogue score (VAS), and lumbar Japanese Orthopaedic Association Scores (JOA) were obtained preoperatively, postoperative 3 days/6 months/12 months, and the last follow-up. 【Results】 All the procedures were successfully completed and the follow-up time was 14.82±1.83 (RA group) and 15.11±1.62 (MIS-TLIF group) months, without significant difference (P>0.05). Compared with MIS-TLIF group, RA group had less intraoperative blood loss [(116.67±18.48) min vs. (128.06±22.53) min], fluoroscopy frequency [(12.42±2.28) vs. (15.67±2.46)], screw placement accuracy (93.18% vs. 84.03%), postoperative drainage [(73.03±23.52) mL vs. (88.33±28.54) mL], and shorter hospitalization stay [(6.45±1.52)d vs. (7.69±1.85) d] (all P0.05). The VAS of lower back pain and lower extremity pain, and lumbar JOA were significantly improved after the operation (P0.05). Meanwhile, fusion rate and incidence of complications did not significantly differ between the two groups (P>0.05). 【Conclusion】 Both robot-assisted MIS-TLIF and MIS-TLIF can achieve excellent clinical effects in treating single-segment lumbar disc herniation. However, the former can improve the accuracy of screw placement and reduce intraoperative blood loss, fluoroscopy frequency, postoperative drainage and hospitalization time, which indicates a promising application.
ABSTRACT
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.
ABSTRACT
Objective To explore the orientation relationships and changing rules of pedicle screw entry point (PSEP) on the posterior bony landmarks in middle-upper thoracic vertebrae in adults by measuring parameters of 3-D reconstruction CT images. Methods CT images of the middle-upper thoracic vertebrae from 30 healthy adults were used for 3-D reconstruction to observe the anatomical characteristics of posterior bony landmarks, including transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina. The following basic parameters, including PSEP-to-midline distance (PMD), transverse process-lamina concave-to-midline distance (CMD) and half lamina width (HLW), and target parameters, including PSEP-to-transverse process-lamina concave distance (PCD), entry point location ratio (EPLR) and PSEP-to-superior ridge of transverse process distance (PRD) were determined on reconstructed CT images from T1 to T10. The differences of bilateral measurements of all parameters and the differences of basic parameters were analyzed, and the changing rules of target parameters measurements from T1 to T10 were summarized. Results The transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina of middle-upper thoracic vertebral characterized by obvious and constant anatomical marks with less proliferative. The left and right PMD, CMD, HLW, PCD, EPLR, and PRD were (14.14±2.63) mm and (14.59±2.58) mm, (10.45±2.12) mm and (10.51±2.02) mm, (16.30±1.48) mm and (16.39±1.61) mm, (4.56±1.03) mm and (4.47±0.94) mm, 0.35±0.26 and 0.33±0.30, and (-1.62±1.90) mm and (-1.63±1.44) mm, respectively. There was no significant difference in the measured values between the two sides of the above parameters (P>0.05). Except that the difference between PMD and HLW in T2 was not significant (P>0.05), the differences between basic parameters in the other segments were statistically significant (P<0.05). PCD of T1 to T10 showed a trend of decrease first and then significant increases in T1, T2, T9, and T10 compared with in T3-T8 (P<0.05). EPLR of T1-T10 showed a trend of increase first and then decrease, in which EPLR in T1, T2 and T3 were significantly lower than in the following any segments (P<0.01), and in the T4-T6 and T10 were significantly lower than in T7-T9 (P<0.01). PRD of T1-T10 showed a trend of increase first and then decrease, in which the PRD in T1, T2 and T3 were significantly lower than in the following any segments, and in the T4-T6 were lower than T7-T10 (P<0.01). Conclusion There is constant orientation relationship and changing rules of PSEP in the middle-upper thoracic vertebrae on the posterior bony landmarks, such as transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina, and it can serve as a new clinical choice.