Original ArticleEffect of Robot-Assisted Surgery on Lumbar Pedicle Screw Internal Fixation in Patients with Osteoporosis
Introduction
The aging population and improvements in life expectancy have led to a variety global public health issues.1, 2 Specifically, the annual incidence rates of osteoporosis and spinal degenerative diseases are increasing. Although pedicle screw internal fixation is a technique used for surgical treatment of spinal pathologies, complications with pedicle screw systems commonly arise in elderly patients. In particular, internal fixation failure and nerve injury can occur when the pedicle screws are placed in osteoporotic vertebrae, as screw insertion may breach the cortical wall.3, 4 Despite the availability of bone cements that can be used to enhance screw anchorage and the stability of internal fixation in osteoporotic vertebrae, microfracture of cortical bone can decrease the holding strength of the screw and increase the risk of bone cement leakage.
Previous studies have shown that achieving accurate screw placement by controlling the angle and trajectory of the pedicle screw without compromising the integrity of the cortical bone is important to enhance the safety of fixation in spinal disorders.5, 6, 7 Accordingly, new technologies provide new options for clinicians. The “TiRobot” orthopedic robot (TINAVI Medical Technologies Co., Ltd., Fenton, Missouri, USA) provides a new technology for the precise placement of pedicle screws. The emergence of this technology may improve the precision of surgical planning, shorten operative time, reduce intraoperative blood loss, and decrease intraoperative radiation exposure to the medical team. The objective of this study was to compare radiologic and clinical outcomes obtained with robot-assisted versus conventional freehand fluoroscopy-assisted pedicle screw insertion in patients with osteoporosis.
Section snippets
Study Population
Patients with osteoporosis and lumbar disease were enrolled in the Department of Spine Surgery, Beijing Jishuitan Hospital between June 2016 and July 2018. Inclusion criteria were 1) age ≥50 years; 2) bone mineral density <80 mg/cm3, evaluated using quantitative computed tomography; 3) diagnosis of a degenerative lumbar disease (e.g., degenerative disk disease, degenerative spondylolisthesis, spondylolytic listhesis, degenerative scoliosis); and 4) treatment with pedicle screw fixation.
Results
This study included 80 patients (25 men and 55 women) with a mean age of 67.71 years (range, 54–80 years). The patients' baseline characteristics are summarized in Table 1. Overall, 35 patients had lumbar spinal stenosis, 26 patients had lumbar disk herniation, and 19 patients had lumbar spondylolisthesis. In the experimental group, 40 patients (12 men and 28 women) with a mean age of 67.55 years (range, 54–78 years) underwent robot-assisted pedicle screw insertion. In the control group, 40
Discussion
The present study compared the radiologic and clinical outcomes of robot-assisted versus conventional freehand fluoroscopy-assisted pedicle screw insertion in patients with osteoporosis and degenerative lumbar disease. The results showed that 98.5% of pedicle screws had a perfect intrapedicular localization after robot-assisted insertion, compared with 91.6% after placement with the freehand technique. In accordance with these findings, previous studies showed that robot-assisted insertion of
Conclusion
The results of the present study show that robot-assisted pedicle screw insertion improves the accuracy of pedicle screw placement and decreases intraoperative blood loss, without increasing operative time, compared with traditional freehand fluoroscopy-assisted pedicle screw insertion in patients with osteoporosis and lumbar diseases. Furthermore, radiation exposure to the medical team was less during robot-assisted surgery. These data suggest that robot-assisted pedicle screw insertion is a
References (23)
- et al.
Intraoperative image guidance compared with free-hand methods in adolescent idiopathic scoliosis posterior spinal surgery: a systematic review on screw-related complications and breach rates
Spine J
(2017) - et al.
Osteoporosis and the management of spinal degenerative disease (II)
Arch Bone Jt Surg
(2017) - et al.
Degenerative inter-vertebral disc disease osteochondrosis intervertebralis in Europe: prevalence, geographic variation and radiological correlates in men and women aged 50 and over
Rheumatology (Oxford)
(2017) - et al.
Imaging features of postoperative complications after spinal surgery and instrumentation
AJR Am J Roentgenol
(2012) - et al.
Accuracy of pedicle screw placement in thoracolumbar spine with conventional open technique
Turk Neurosurg
(2014) - et al.
The accuracy of navigation and 3D image-guided placement for the placement of pedicle screws in congenital spine deformity
J Pediatr Orthop
(2012) - et al.
Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system
Spine (Phila Pa 1976)
(2015) - et al.
A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation
Spine (Phila Pa 1976)
(2012) - et al.
Accuracy of pedicular screw placement in vivo
Spine (Phila Pa 1976)
(1990) - et al.
Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review
Eur Spine J
(2015)
Accuracy of pedicle screw placement comparing robot-assisted technology and the free-hand with fluoroscopy-guided method in spine surgery: an updated meta-analysis
Medicine (Baltimore)
Cited by (43)
Robotics and navigation in spine surgery: A narrative review
2023, Journal of OrthopaedicsComparing radiation dose of image-guided techniques in lumbar fusion surgery with pedicle screw insertion; A systematic review
2023, North American Spine Society JournalAssociation of robot-assisted techniques with the accuracy rates of pedicle screw placement: A network pooling analysis
2022, eClinicalMedicineCitation Excerpt :The subgroup analysis showed that the ROSA (MD, 74.00; [95% CI, 51.81 to 96.19]) robot-assisted technique was associated with longer operative time than the conventional freehand technique (Supplementary Figure 23). Two studies (92 participants, 661 pedicle screws) compared the differences in per pedicle screw time.28,39 The pooled estimates (Supplementary Figure 24) showed no difference in pedicle screw time between robotic-assisted techniques and the conventional freehand technique (MD, -1.20; [95% CI, -3.17 to 0.77]).
Bony fixation in the era of spinal robotics: A systematic review and meta-analysis
2022, Journal of Clinical Neuroscience
Conflict of interest statement: This work was supported by the National Key R&D Program of China [2016YFC0105800] and the National High Technology Research and Development Program of China [2015AA043201].