The safety of TiRobot-guided percutaneous transpedicular screw implantation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIN Shu , HU Jiang , WAN Lun ,  TANG Liuyi , WANG Yue , YU Yang , ZHANG Wei

Department of Orthopedics, Sichuan Academy of Medical Science, People’s Hospital of Sichuan Province, Chengdu Sichuan, 610072, P.R.China;

Corresponding?author：

TANG Liuyi, Email: 18981838527@189.cn

Keywords：

Robot; percutaneous screw implantation; thoracolumbar fracture; lumbar degenerative disease; safety

DOI：

10.7507/1002-1892.202103072

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the safety of TiRobot-guided percutaneous transpedicular screw implantation.Methods The medical records of 158 patients with thoracolumbar fractures and lumbar degenerative diseases who underwent percutaneous transpedicular screw implantation were retrospectively analyzed between January 2018 and December 2020. The patients were divided into trial group (TiRobot-guided screw implantation, 86 cases) and control group (fluoroscopy-guided screw implantation, 72 cases). There was no significant difference in gender, age, pathology, lesion segment, and the average number of screw implantation per case (P>0.05). The operation time, fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency were compared between the two groups. One day postoperatively, the convergence angle was measured and the penetration of the pedicle cortex was evaluated according to Gertzbein-Robbins classification standard.Results The operation time, fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency of the trial group were significantly lesser than those of control group (P<0.05).One day postoperatively, the convergence angle of trial group was (21.10±4.08)°, which was significantly larger than control group (19.17±3.48)° (t=6.810, P=0.000). According to the Gertzbein-Robbins classification standard, 446 pedicle screws were implanted in trial group, trajectories were grade A in 377 screws, grade B in 46 screws, grade C in 23 screws, and the accuracy of screw implantation was 94.8%; 380 pedicle screws were implanted in control group, trajectories were grade A in 283 screws, grade B in 45 screws, grade C in 44 screws, grade D in 6 screws, grade E in 2 screws, and the accuracy of screw implantation was 86.3%. There was significant difference in the accuracy of screw implantation between the two groups (χ²=25.950, P=0.000). Conclusion Compared with traditional percutaneous transpedicular screw implantation, TiRobot-guided percutaneous transpedicular screw implantation can improve the accuracy of screw implantation, reduce radiation exposure, and improve surgical safety, which has a good application prospect.

Citation： LIN Shu, HU Jiang, WAN Lun, TANG Liuyi, WANG Yue, YU Yang, ZHANG Wei. The safety of TiRobot-guided percutaneous transpedicular screw implantation. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(7): 813-817. doi: 10.7507/1002-1892.202103072 Copy

1.	楊佳寧, 趙勝軍, 趙麗麗, 等. 微創通道下 MIS-TLIF 聯合經皮椎弓根螺釘治療腰椎滑脫癥的臨床療效觀察. 中國矯形外科雜志, 2019, 27(3): 273-276.
2.	祝乃強, 侯靜怡, 馬桂云, 等. 經皮椎弓根螺釘內固定治療胸腰椎骨折. 中國矯形外科雜志, 2019, 18(9): 1663-1668.
3.	范明星, 張琦, 趙經緯, 等. 機器人輔助經皮微創單節段胸腰椎骨折內固定術的學習曲線. 中國微創外科雜志, 2019, 19(9): 808-811.
4.	Yu L, Chen X, Margalit A, et al. Robot-assisted vs freehand pedicle screw fixation in spine surgery—a systematic review and a meta-analysis of comparative studies. Int J Med Robot, 2018, 14(3): e1892.
5.	曹旭含, 白子興, 孫承頤, 等. 機器人在骨科手術中應用的可靠性與提升空間. 中國組織工程研究, 2020, 24(9): 1416-1421.
6.	高陽陽, 車先達, 韓鵬飛, 等. 透視引導與機器人輔助椎弓根置釘效果的薈萃分析. 中國組織工程研究, 2020, 24(3): 446-452.
7.	張在田, 張緒華, 衛志華, 等. 機器人輔助與徒手單側穿刺椎體成形術治療骨質疏松性椎體壓縮骨折療效的比較. 骨科臨床與研究雜志, 2018, 3(4): 205-208.
8.	林書, 胡豇, 萬侖, 等. 骨科機器人輔助經皮椎體后凸成形治療多節段脊柱轉移瘤. 中國組織工程研究, 2020, 24(33): 5249-5254.
9.	茅劍平, 張琦, 范明星, 等. 機器人輔助與徒手置入椎弓根螺釘在經椎間孔腰椎椎間融合術中的對比研究. 中國微創外科雜志, 2019, 19(6): 481-484, 489.
10.	Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
11.	林書, 胡豇, 萬侖, 等. 機器人與透視輔助經皮椎弓根螺釘置入的比較. 中國矯形外科雜志, 2020, 28(20): 1830-1834.
12.	Sukovich W, Brink-Danan S, Hardenbrook M. Miniature robotic guidance for pedicle screw placement in posterior spinal fusion: early clinical experience with the SpineAssist. Int J Med Robot, 2006, 2(2): 114-122.
13.	Pechlivanis I, Kiriyanthan G, Engelhardt M, et al. Percutaneous placement of pedicle screws in the lumbar spine using a bone mounted miniature robotic system: first experiences and accuracy of screw placement. Spine (Phila Pa 1976), 2009, 34(4): 392-398.
14.	Macke JJ, Woo R, Varich L. Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population. J Robot Surg, 2016, 10(2): 145-150.
15.	Onen MR, Simsek M, Naderi S. Robotic spine surgery: a preliminary report. Turk Neurosurg, 2014, 24(4): 512-518.
16.	Schatlo B, Martinez R, Alaid A, et al. Unskilled unawareness and the learning curve in robotic spine surgery. Acta Neurochir (Wien), 2015, 157(10): 1819-1823.
17.	Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
18.	Hyun SJ, Kim KJ, Jahng TA, et al. Minimally invasive, robotic versus open fluoroscopic-guided spinal instrumented fusions—a randomized, controlled trial. Spine (Phila Pa 1976), 2017, 42(6): 353-358.
19.	Kim HJ, Jung WI, Chang BS, et al. A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery. Int J Med Robot, 2017, 13(3). doi: 10.1002/rcs.1779.
20.	Roser F, Tatagiba M, Maier G. Spinal robotics: current applications and future perspectives. Neurosurgery, 2013, 72 Suppl 1: 12-18.
21.	Keric N, Eum DJ, Afghanyar F, et al. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis. J Robot Surg, 2017, 11(1): 17-25.
22.	Molliqaj G, Schatlo B, Alaid A, et al. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus, 2017, 42(5): E14. doi: 10.3171/2017.3.FOCUS179.
23.	Lonjon N, Chan-Seng E, Costalat V, et al. Robot-assisted spine surgery: feasibility study through a prospective case-matched analysis. Eur Spine J, 2016, 25(3): 947-955.
24.	Ringel F, Stüer C, Reinke A, et al. Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: a prospective randomized comparison to conventional freehand screw implantation. Spine (Phila Pa 1976), 2012, 37(8): E496-501.
25.	Zhang Q, Xu YF, Tian W, et al. Comparison of superior-level facet joint violations between robot-assisted percutaneous pedicle screw placement and conventional open fluoroscopic-guided pedicle screw placement. Orthop Surg, 2019, 11(5): 850-856.
26.	Feng S, Tian W, Sun Y, et al. Effect of robot-assisted surgery on lumbar pedicle screw internal fixation in patients with osteoporosis. World Neurosurg, 2019, 125: e1057-e1062.
27.	Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019. doi: 10.3171/2018.10.SPINE18487.
28.	Yang JS, He B, Tian F, et al. Accuracy of robot-assisted percutaneous pedicle screw placement for treatment of lumbar spondylolisthesis: A comparative cohort study. Med Sci Monit, 2019, 25: 2479-2487.
29.	Kantelhardt SR, Martinez R, Baerwinkel S, et al. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J, 2011, 20(6): 860-868.
30.	Schizas C, Thein E, Kwiatkowski B, et al. Pedicle screw insertion: robotic assistance versus conventional C-arm fluoroscopy. Acta Orthop Belg, 2012, 78(2): 240-245.
31.	Solomiichuk V, Fleischhammer J, Molliqaj G, et al. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison. Neurosurg Focus, 2017, 42(5): E13.
32.	徐鵬, 葛鵬, 章仁杰, 等. 機器人輔助下椎弓根螺釘固定治療胸腰椎骨折. 頸腰痛雜志, 2018, 39(6): 687-690.
33.	陳龍, 海涌, 關立, 等. 機器人輔助置入與徒手置入椎弓根螺釘的對比研究. 中國骨與關節雜志, 2017, 6(10): 730-736.
34.	李浩, 方宣城, 邱新建, 等. 機器人輔助與 “C” 型臂 X 線機透視經皮微創椎弓根螺釘內固定治療胸腰椎骨折療效的比較. 骨科臨床與研究雜志, 2018, 3(4): 200-204.

1. 楊佳寧, 趙勝軍, 趙麗麗, 等. 微創通道下 MIS-TLIF 聯合經皮椎弓根螺釘治療腰椎滑脫癥的臨床療效觀察. 中國矯形外科雜志, 2019, 27(3): 273-276.
2. 祝乃強, 侯靜怡, 馬桂云, 等. 經皮椎弓根螺釘內固定治療胸腰椎骨折. 中國矯形外科雜志, 2019, 18(9): 1663-1668.
3. 范明星, 張琦, 趙經緯, 等. 機器人輔助經皮微創單節段胸腰椎骨折內固定術的學習曲線. 中國微創外科雜志, 2019, 19(9): 808-811.
4. Yu L, Chen X, Margalit A, et al. Robot-assisted vs freehand pedicle screw fixation in spine surgery—a systematic review and a meta-analysis of comparative studies. Int J Med Robot, 2018, 14(3): e1892.
5. 曹旭含, 白子興, 孫承頤, 等. 機器人在骨科手術中應用的可靠性與提升空間. 中國組織工程研究, 2020, 24(9): 1416-1421.
6. 高陽陽, 車先達, 韓鵬飛, 等. 透視引導與機器人輔助椎弓根置釘效果的薈萃分析. 中國組織工程研究, 2020, 24(3): 446-452.
7. 張在田, 張緒華, 衛志華, 等. 機器人輔助與徒手單側穿刺椎體成形術治療骨質疏松性椎體壓縮骨折療效的比較. 骨科臨床與研究雜志, 2018, 3(4): 205-208.
8. 林書, 胡豇, 萬侖, 等. 骨科機器人輔助經皮椎體后凸成形治療多節段脊柱轉移瘤. 中國組織工程研究, 2020, 24(33): 5249-5254.
9. 茅劍平, 張琦, 范明星, 等. 機器人輔助與徒手置入椎弓根螺釘在經椎間孔腰椎椎間融合術中的對比研究. 中國微創外科雜志, 2019, 19(6): 481-484, 489.
10. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
11. 林書, 胡豇, 萬侖, 等. 機器人與透視輔助經皮椎弓根螺釘置入的比較. 中國矯形外科雜志, 2020, 28(20): 1830-1834.
12. Sukovich W, Brink-Danan S, Hardenbrook M. Miniature robotic guidance for pedicle screw placement in posterior spinal fusion: early clinical experience with the SpineAssist. Int J Med Robot, 2006, 2(2): 114-122.
13. Pechlivanis I, Kiriyanthan G, Engelhardt M, et al. Percutaneous placement of pedicle screws in the lumbar spine using a bone mounted miniature robotic system: first experiences and accuracy of screw placement. Spine (Phila Pa 1976), 2009, 34(4): 392-398.
14. Macke JJ, Woo R, Varich L. Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population. J Robot Surg, 2016, 10(2): 145-150.
15. Onen MR, Simsek M, Naderi S. Robotic spine surgery: a preliminary report. Turk Neurosurg, 2014, 24(4): 512-518.
16. Schatlo B, Martinez R, Alaid A, et al. Unskilled unawareness and the learning curve in robotic spine surgery. Acta Neurochir (Wien), 2015, 157(10): 1819-1823.
17. Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
18. Hyun SJ, Kim KJ, Jahng TA, et al. Minimally invasive, robotic versus open fluoroscopic-guided spinal instrumented fusions—a randomized, controlled trial. Spine (Phila Pa 1976), 2017, 42(6): 353-358.
19. Kim HJ, Jung WI, Chang BS, et al. A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery. Int J Med Robot, 2017, 13(3). doi: 10.1002/rcs.1779.
20. Roser F, Tatagiba M, Maier G. Spinal robotics: current applications and future perspectives. Neurosurgery, 2013, 72 Suppl 1: 12-18.
21. Keric N, Eum DJ, Afghanyar F, et al. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis. J Robot Surg, 2017, 11(1): 17-25.
22. Molliqaj G, Schatlo B, Alaid A, et al. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus, 2017, 42(5): E14. doi: 10.3171/2017.3.FOCUS179.
23. Lonjon N, Chan-Seng E, Costalat V, et al. Robot-assisted spine surgery: feasibility study through a prospective case-matched analysis. Eur Spine J, 2016, 25(3): 947-955.
24. Ringel F, Stüer C, Reinke A, et al. Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: a prospective randomized comparison to conventional freehand screw implantation. Spine (Phila Pa 1976), 2012, 37(8): E496-501.
25. Zhang Q, Xu YF, Tian W, et al. Comparison of superior-level facet joint violations between robot-assisted percutaneous pedicle screw placement and conventional open fluoroscopic-guided pedicle screw placement. Orthop Surg, 2019, 11(5): 850-856.
26. Feng S, Tian W, Sun Y, et al. Effect of robot-assisted surgery on lumbar pedicle screw internal fixation in patients with osteoporosis. World Neurosurg, 2019, 125: e1057-e1062.
27. Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019. doi: 10.3171/2018.10.SPINE18487.
28. Yang JS, He B, Tian F, et al. Accuracy of robot-assisted percutaneous pedicle screw placement for treatment of lumbar spondylolisthesis: A comparative cohort study. Med Sci Monit, 2019, 25: 2479-2487.
29. Kantelhardt SR, Martinez R, Baerwinkel S, et al. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J, 2011, 20(6): 860-868.
30. Schizas C, Thein E, Kwiatkowski B, et al. Pedicle screw insertion: robotic assistance versus conventional C-arm fluoroscopy. Acta Orthop Belg, 2012, 78(2): 240-245.
31. Solomiichuk V, Fleischhammer J, Molliqaj G, et al. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison. Neurosurg Focus, 2017, 42(5): E13.
32. 徐鵬, 葛鵬, 章仁杰, 等. 機器人輔助下椎弓根螺釘固定治療胸腰椎骨折. 頸腰痛雜志, 2018, 39(6): 687-690.
33. 陳龍, 海涌, 關立, 等. 機器人輔助置入與徒手置入椎弓根螺釘的對比研究. 中國骨與關節雜志, 2017, 6(10): 730-736.
34. 李浩, 方宣城, 邱新建, 等. 機器人輔助與 “C” 型臂 X 線機透視經皮微創椎弓根螺釘內固定治療胸腰椎骨折療效的比較. 骨科臨床與研究雜志, 2018, 3(4): 200-204.

Chinese Journal of Reparative and Reconstructive Surgery

The safety of TiRobot-guided percutaneous transpedicular screw implantation

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