Clinical and Radiologic Outcomes of Robot-Assisted Kyphoplasty versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Comparative Study.

BACKGROUND: Making surgery as less aggressive as possible is best for elderly patients with osteoporotic vertebral compression fractures (OVCFs). Recently, we attempted a more precise, minimally invasive, and robot-assisted kyphoplasty in our clinical setting. OBJECTIVE: We sought to compare the clinical and radiologic outcomes of robot-assisted percutaneous kyphoplasty (rPKP) with those of fluoroscopy-assisted percutaneous kyphoplasty (fPKP) in treating OVCFs. METHODS: We retrospectively reviewed the clinical and radiologic data of patients with single-segment OVCF who received either rPKP or fPKP between January 2020 and December 2020 at our institution. The operation time, injected volume of cement, length of hospital stays, visual analog scale for back pain, Oswestry Disability Index, local kyphosis angle (LKA), height of fractured vertebra (HFV), and perioperative complications were compared between the 2 groups. RESULTS: A total of 212 cases were included in this study, among whom 81 cases received rPKP and 131 cases received fPKP. Both techniques exhibited satisfying improvement in pain relief and radiologic outcomes. Specifically, the rPKP costed less operation time and achieved better correction and maintenance regarding LKA, HFV, and instant pain relief (P < 0.05). The length of hospital stays, incidence of cement leakage, visual analog scale for back pain, and Oswestry Disability Index at final follow-up were comparable between 2 groups. CONCLUSIONS: rPKP provides a precise puncture and exhibits superiority in the correction and maintenance of LKA and HFV when compared with traditional fPKP. The cost-effectiveness and specific application scenarios of this technique shall be confirmed via further extensive studies.

Does Robot Navigation and Intraoperative Computed Tomography Guidance Help with Percutaneous Endoscopic Lumbar Discectomy? A Match-Paired Study.

OBJECTIVE: To evaluate the efficacy and safety of robot-assisted percutaneous endoscopic lumbar discectomy (rPELD) using a specially designed orthopaedic robot with an intraoperative computed tomography-equipped suite for treatment of symptomatic lumbar disc herniation and compare rPELD with fluoroscopy-assisted percutaneous endoscopic lumbar discectomy (fPELD). METHODS: We retrospectively reviewed and compared demographic data, radiologic workups, and patient-reported outcomes of 39 patients treated with rPELD and 78 patients treated with fPELD at our institution between January 2019 and December 2019. RESULTS: Our data showed that a single-shot puncture in the rPELD group was significantly more precise compared with 4.12 ± 1.71 trials in the fPELD group (P < 0.001). There was an overall reduction of fluoroscopy (21.33 ± 3.89 times vs. 33.06 ± 2.92 times, P < 0.001), puncture-channel time (13.34 ± 3.03 minutes vs. 15.03 ± 4.5 minutes, P = 0.038), and total operative time (57.46 ± 7.49 minutes vs. 69.40 ± 12.59 minutes, P < 0.001) using the rPELD technique versus the fPELD technique. However, there were no significant differences in patient-reported outcomes, length of hospital stay, and complication rate between the 2 groups (P > 0.05). CONCLUSIONS: Taken together, our data indicate that rPELD provides a precise skin entry point and optimal trajectory for puncture, which increases the success rate of PELD, negating the need for revision surgery. However, further studies are required to confirm the superiority and application of the rPELD technique.