Effectiveness of robot-guided percutaneous fixation and decompression via small incision for advanced thoracolumbar metastases_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Jiahong , LIN Shu , TANG Liuyi , HU Jiang , WAN Lun , ZHANG Kun ,  LIANG Weimin , WANG Shan

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

Corresponding?author：

LIANG Weimin, Email: liangbsb@126.com

Keywords：

Orthopedic robot; thoracolumbar spine; metastases; percutaneous fixation; minimal invasive surgery; open surgery

DOI：

10.7507/1002-1892.202305040

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Objective To evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases. Methods A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups (P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading. Results During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups (P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group (P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups (P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation (P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation (P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group (P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group (P>0.05). Median overall survival time was 13 months [95%CI (10.858, 15.142) months] in the robot-guided group and 15 months [95%CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups (χ²=0.561, P=0.454) . Conclusion Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.

Citation： LI Jiahong, LIN Shu, TANG Liuyi, HU Jiang, WAN Lun, ZHANG Kun, LIANG Weimin, WANG Shan. Effectiveness of robot-guided percutaneous fixation and decompression via small incision for advanced thoracolumbar metastases. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(9): 1113-1118. doi: 10.7507/1002-1892.202305040 Copy

1.	Sullivan PZ, Niu T, Abinader JF, et al. Evolution of surgical treatment of metastatic spine tumors. J Neurooncol, 2022, 157(2): 277-283.
2.	Orenday-Barraza JM, Cavagnaro MJ, Avila MJ, et al. 10-year trends in the surgical management of patients with spinal metastases: a scoping review. World Neurosurg, 2022, 157: 170-186.
3.	肖渝, 夏萍, 張漾杰, 等. 微創技術在脊柱腫瘤中的研究進展. 腫瘤預防與治療, 2023, 36(2): 162-167.
4.	趙雄偉, 曹敘勇, 劉耀升. 脊柱轉移瘤微創手術的研究進展. 中華骨與關節外科雜志, 2022, 15(7): 554-560.
5.	田偉, 范明星, 張琦, 等. 中國骨科手術機器人的發展. 應用力學學報, 2023, 40(1): 1-6.
6.	朱振中, 鄭國焱, 張長青. 機器人輔助技術在創傷骨科的發展與臨床應用. 中國修復重建外科雜志, 2022, 36(8): 915-922.
7.	孟磊, 張貫林, 李東風, 等.“天璣”骨科手術機器人輔助下經皮椎弓根釘內固定治療胸腰椎骨折的療效觀察. 中國骨與關節損傷雜志, 2022, 37(7): 705-708.
8.	張同同, 王增平, 王中華, 等. 骨科機器人輔助下脊柱椎弓根螺釘置入準確性與安全性的臨床研究. 中國骨傷, 2022, 35(2): 108-112.
9.	Perfetti DC, Kisinde S, Rogers-LaVanne MP, et al. Robotic spine surgery: past, present, and future. Spine (Phila Pa 1976), 2022, 47(13): 909-921.
10.	Lin S, Wang F, Hu J, et al. Comparison of the accuracy and safety of tirobot-assisted and fluoroscopy-assisted percutaneous pedicle screw placement for the treatment of thoracolumbar fractures. Orthop Surg, 2022, 14(11): 2955-2963.
11.	Huang M, Tetreault TA, Vaishnav A, et al. The current state of navigation in robotic spine surgery. Ann Transl Med, 2021, 9(1): 86.
12.	Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976), 2010, 35(22): E1221-E1229.
13.	Bollen L, van der Linden YM, Pondaag W, et al. Prognostic factors associated with survival in patients with symptomatic spinal bone metastases: a retrospective cohort study of 1, 043 patients. Neuro Oncol, 2014, 16(7): 991-998.
14.	Tomita K, Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases. Spine (Phila Pa 1976), 2001, 26(3): 298-306.
15.	Tokuhashi Y, Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976), 2005, 30(19): 2186-2191.
16.	Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
17.	Morgen SS, Hansen LV, Karbo T, et al. Minimal access vs. open spine surgery in patients with metastatic spinal cord compression—A one-center randomized controlled trial. Anticancer Res, 2020, 40(10): 5673-5678.
18.	林書, 胡豇, 萬侖, 等. “天璣”骨科機器人輔助下經皮椎弓根螺釘植釘安全性評價. 中國修復重建外科雜志, 2021, 35(7): 813-817.
19.	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.
20.	仉建國, 莊乾宇. 脊柱大手術圍術期血液管理專家共識. 中國脊柱脊髓雜志, 2022, 32(11): 1049-1056.
21.	Zhu X, Lu J, Xu H, et al. A comparative study between minimally invasive spine surgery and traditional open surgery for patients with spinal metastasis. Spine (Phila Pa 1976), 2021, 46(1): 62-68.
22.	Saadeh YS, Elswick CM, Fateh JA, et al. Analysis of outcomes between traditional open versus mini-open approach in surgical treatment of spinal metastasis. World Neurosurg, 2019, 130: e467-e474.
23.	Hansen-Algenstaedt N, Kwan MK, Algenstaedt P, et al. Comparison between minimally invasive surgery and conventional open surgery for patients with spinal metastasis: a prospective propensity score-matched study. Spine (Phila Pa 1976), 2017, 42(10): 789-797.
24.	Kumar N, Malhotra R, Maharajan K, et al. Metastatic spine tumor surgery: a comparative study of minimally invasive approach using percutaneous pedicle screws fixation versus open approach. Clin Spine Surg, 2017, 30(8): E1015-E1021.
25.	Flynn SC, Eli IM, Ghogawala Z, et al. Minimally invasive surgery for spinal metastasis: a review. World Neurosurg, 2022, 159: e32-e39.
26.	Pranata R, Lim MA, Vania R, et al. Minimal invasive surgery instrumented fusion versus conventional open surgical instrumented fusion for the treatment of spinal metastases: a systematic review and meta-analysis. World Neurosurg, 2021, 148: e264-e274.
27.	Ntilikina Y, Collinet A, Tigan LV, et al. Comparison of open versus minimally invasive surgery in the treatment of thoracolumbar metastases. Orthop Traumatol Surg Res, 2022, 108(4): 103274.

1. Sullivan PZ, Niu T, Abinader JF, et al. Evolution of surgical treatment of metastatic spine tumors. J Neurooncol, 2022, 157(2): 277-283.
2. Orenday-Barraza JM, Cavagnaro MJ, Avila MJ, et al. 10-year trends in the surgical management of patients with spinal metastases: a scoping review. World Neurosurg, 2022, 157: 170-186.
3. 肖渝, 夏萍, 張漾杰, 等. 微創技術在脊柱腫瘤中的研究進展. 腫瘤預防與治療, 2023, 36(2): 162-167.
4. 趙雄偉, 曹敘勇, 劉耀升. 脊柱轉移瘤微創手術的研究進展. 中華骨與關節外科雜志, 2022, 15(7): 554-560.
5. 田偉, 范明星, 張琦, 等. 中國骨科手術機器人的發展. 應用力學學報, 2023, 40(1): 1-6.
6. 朱振中, 鄭國焱, 張長青. 機器人輔助技術在創傷骨科的發展與臨床應用. 中國修復重建外科雜志, 2022, 36(8): 915-922.
7. 孟磊, 張貫林, 李東風, 等.“天璣”骨科手術機器人輔助下經皮椎弓根釘內固定治療胸腰椎骨折的療效觀察. 中國骨與關節損傷雜志, 2022, 37(7): 705-708.
8. 張同同, 王增平, 王中華, 等. 骨科機器人輔助下脊柱椎弓根螺釘置入準確性與安全性的臨床研究. 中國骨傷, 2022, 35(2): 108-112.
9. Perfetti DC, Kisinde S, Rogers-LaVanne MP, et al. Robotic spine surgery: past, present, and future. Spine (Phila Pa 1976), 2022, 47(13): 909-921.
10. Lin S, Wang F, Hu J, et al. Comparison of the accuracy and safety of tirobot-assisted and fluoroscopy-assisted percutaneous pedicle screw placement for the treatment of thoracolumbar fractures. Orthop Surg, 2022, 14(11): 2955-2963.
11. Huang M, Tetreault TA, Vaishnav A, et al. The current state of navigation in robotic spine surgery. Ann Transl Med, 2021, 9(1): 86.
12. Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976), 2010, 35(22): E1221-E1229.
13. Bollen L, van der Linden YM, Pondaag W, et al. Prognostic factors associated with survival in patients with symptomatic spinal bone metastases: a retrospective cohort study of 1, 043 patients. Neuro Oncol, 2014, 16(7): 991-998.
14. Tomita K, Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases. Spine (Phila Pa 1976), 2001, 26(3): 298-306.
15. Tokuhashi Y, Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976), 2005, 30(19): 2186-2191.
16. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
17. Morgen SS, Hansen LV, Karbo T, et al. Minimal access vs. open spine surgery in patients with metastatic spinal cord compression—A one-center randomized controlled trial. Anticancer Res, 2020, 40(10): 5673-5678.
18. 林書, 胡豇, 萬侖, 等. “天璣”骨科機器人輔助下經皮椎弓根螺釘植釘安全性評價. 中國修復重建外科雜志, 2021, 35(7): 813-817.
19. 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.
20. 仉建國, 莊乾宇. 脊柱大手術圍術期血液管理專家共識. 中國脊柱脊髓雜志, 2022, 32(11): 1049-1056.
21. Zhu X, Lu J, Xu H, et al. A comparative study between minimally invasive spine surgery and traditional open surgery for patients with spinal metastasis. Spine (Phila Pa 1976), 2021, 46(1): 62-68.
22. Saadeh YS, Elswick CM, Fateh JA, et al. Analysis of outcomes between traditional open versus mini-open approach in surgical treatment of spinal metastasis. World Neurosurg, 2019, 130: e467-e474.
23. Hansen-Algenstaedt N, Kwan MK, Algenstaedt P, et al. Comparison between minimally invasive surgery and conventional open surgery for patients with spinal metastasis: a prospective propensity score-matched study. Spine (Phila Pa 1976), 2017, 42(10): 789-797.
24. Kumar N, Malhotra R, Maharajan K, et al. Metastatic spine tumor surgery: a comparative study of minimally invasive approach using percutaneous pedicle screws fixation versus open approach. Clin Spine Surg, 2017, 30(8): E1015-E1021.
25. Flynn SC, Eli IM, Ghogawala Z, et al. Minimally invasive surgery for spinal metastasis: a review. World Neurosurg, 2022, 159: e32-e39.
26. Pranata R, Lim MA, Vania R, et al. Minimal invasive surgery instrumented fusion versus conventional open surgical instrumented fusion for the treatment of spinal metastases: a systematic review and meta-analysis. World Neurosurg, 2021, 148: e264-e274.
27. Ntilikina Y, Collinet A, Tigan LV, et al. Comparison of open versus minimally invasive surgery in the treatment of thoracolumbar metastases. Orthop Traumatol Surg Res, 2022, 108(4): 103274.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of robot-guided percutaneous fixation and decompression via small incision for advanced thoracolumbar metastases

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