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Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis

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Abstract

Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the application of intervertebral cages. In this collective, we compare conventional open to a further minimalized percutaneous robot-assisted spinal instrumentation, avoiding a direct contact of implants and infectious focus. 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments with and without decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. 24 patients were treated by free-hand fluoroscopy-guided surgery (121 screws), and 66 patients were treated by percutaneous robot-assisted spinal instrumentation (341 screws). Accurate screw placement was confirmed in 90 % of robot-assisted and 73.5 % of free-hand placed screws. Implant revision due to misplacement was necessary in 4.95 % of the free-hand group compared to 0.58 % in the robot-assisted group. The average intraoperative X-ray exposure per case was 0.94 ± 1.04 min in the free-hand group vs. 0.4 ± 0.16 min in the percutaneous group (p = 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (p = 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis.

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Acknowledgments

Results of this article are parts of the ongoing doctoral thesis of F. A.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of the Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    Naureen Keric, David J. Eum, Feroz Afghanyar, Mirjam Renovanz, Jens Conrad, Dominik M. A. Wesp, Sven R. Kantelhardt & Alf Giese

  2. Department of Neurosurgery, German Red Cross-Pain Center, Mainz, Germany

    David J. Eum

  3. Institute of Neuroradiology, University of Mainz, Mainz, Germany

    Izabela Rachwal-Czyzewicz

  4. Radiology Institute, Gdansk, Poland

    Izabela Rachwal-Czyzewicz

Authors
  1. Naureen Keric
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  2. David J. Eum
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  3. Feroz Afghanyar
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  4. Izabela Rachwal-Czyzewicz
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  5. Mirjam Renovanz
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  6. Jens Conrad
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  7. Dominik M. A. Wesp
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  8. Sven R. Kantelhardt
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  9. Alf Giese
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Correspondence to Naureen Keric.

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Funding

No funding has been received in favor of this study.

Conflict of interest

Author NK declares that she has no conflict of interest. Author DJE declares that he has no conflict of interest. Author FA declares that he has no conflict of interest. Author IR-C declares that she has no conflict of interest. Author MR declares that she has no conflict of interest. Author JC declares that he has no conflict of interest. Author DMAW declares that he has no conflict of interest. Author SRK declares that he has no conflict of interest. Author AG declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. According to the laws of the local ethics committee, for this type of retrospective study, an ethical approval and a formal patient consent are not required.

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Keric, N., Eum, D.J., Afghanyar, F. et al. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis. J Robotic Surg 11, 17–25 (2017). https://doi.org/10.1007/s11701-016-0597-5

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  • DOI: https://doi.org/10.1007/s11701-016-0597-5

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