Application of robot-assisted endoscopic lumbar decompression and fusion in single segment lumbar fusion surgery_West China Medical Journal

Authors：

 ZHOU Qing , ZHOU Yu , LIU Yuehong , CHEN Xi , QIN Wei , ZHANG Desheng , WANG Zhicong

Department of Orthopedics, Deyang People’s Hospital / Orthopedic Center of Deyang City, Deyang, Sichuan 618000, P. R. China;

Corresponding author：

ZHOU Qing, Email: 45061797@qq.com

Keywords：

Orthopedic robot; endoscopes; spinal fusion

DOI：

10.7507/1002-0179.202108194

Video：

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Objective To explore the application of robot-assisted pedicle screw fixation combined with total endoscopic decompression and interbody fusion in single segment lumbar decompression and fusion. Methods A total of 27 cases undergoing single segment lumbar decompression and fusion between August 2020 and May 2021 in the People’s Hospital of Deyang City were retrospectively collected. They were divided into group A and B according to their surgery method. The patients in group A underwent robot-assisted pedicle screw fixation combined with total endoscopic decompression and interbody fusion surgery, while the ones in group B underwent traditional posterior decompression and fusion. The operation time, amount of bleeding, Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) score before operation and one month and three months after operation, and success rate of screw placement were compared. Results There were 12 patients in group A, 5 males and 7 females, aged (59.83±6.79) years, and 15 patients in group B, 6 males and 9 females, aged (53.73±14.87) years. The amount of intraoperative bleeding [(195.00±45.23) vs. (240.00±47.06) mL] and postoperative hospital stay [(5.92±1.56) vs. (8.33±3.62) d] in group A were less than those in group B (P<0.05), while the operation time [(185.80±52.13) vs. (160.70±21.37) min] and the success rate of screw placement [100.0% (48/48) vs. 96.7% (58/60)] had no statistical difference between the two groups (P>0.05). The VAS score and ODI score of the two groups decreased significantly over time (P<0.05), but there was no significant difference in VAS score between the two groups at the same time point before operation, one month after operation, or three months after operation (P>0.05). The ODI score of group A was better than that of group B one month after operation (P=0.010), but there was no significant difference between the two groups before operation or three months after operation (P>0.05). Conclusion Compared with traditional open surgery, the application of robot-assisted total endoscopic lumbar decompression and fusion technology in single segment lumbar fusion has good early clinical outcome, high success rate of screw placement, and small trauma, which is beneficial to early functional recovery and has the significance of further exploring its application prospect.

Citation： ZHOU Qing, ZHOU Yu, LIU Yuehong, CHEN Xi, QIN Wei, ZHANG Desheng, WANG Zhicong. Application of robot-assisted endoscopic lumbar decompression and fusion in single segment lumbar fusion surgery. West China Medical Journal, 2022, 37(10): 1465-1470. doi: 10.7507/1002-0179.202108194 Copy

1.	Wearn B, Yue WM, Yew PS, et al. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976), 2009, 34(13): 1385.
2.	Lee KH, Yue WM, Yeo W, et al. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J, 2012, 21(11): 2265-2270.
3.	周跃, 王健, 初同伟, 等. 经皮椎弓根螺钉固定、内窥镜下腰椎管减压、椎间融合的临床应用. 中国脊柱脊髓杂志, 2007, 17(5): 333-336.
4.	Nowitzke AM. Assessment of the learning curve for lumbar microendoscopic discectomy. Neurosurgery, 2005, 56(4): 755-762.
5.	Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2): 98-105.
6.	Osman SG. Endoscopic transforaminal decompression, interbody fusion, and percutaneous pedicle screw implantation of the lumbar spine: a case series report. Int J Spine Surg, 2012, 6: 157-166.
7.	Wu J, Liu H, Ao S, et al. Percutaneous endoscopic lumbar interbody fusion: technical note and preliminary clinical experience with 2-year follow-up. Biomed Res Int, 2018, 2018: 5806037.
8.	Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
9.	Castro WH, Halm H, Jerosch J, et al. Accuracy of pedicle screw placement in lumbar vertebrae. Spine (Phila Pa 1976), 1996, 21(11): 1320-1324.
10.	Amato V, Giannachi L, Irace C, et al. Accuracy of pedicle screw placement in the lumbosacral spine using conventional technique: computed tomography postoperative assessment in 102 consecutive patients. J Neurosurg Spine, 2010, 12(3): 306-313.
11.	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.
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.	Barzilay Y, Liebergall M, Fridlander A, et al. Miniature robotic guidance for spine surgery-introduction of a novel system and analysis of challenges encountered during the clinical development phase at two spine centres. Int J Med Robot, 2006, 2(2): 146-153.
14.	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.
15.	Cannestra AF. Significant decreased radiation exposure in percutaneous adult degenerative spinal instrumentation with robotic guidance. Spine J, 2014, 14(11): S171.
16.	肖宇, 龙浩, 何祖波, 等. 骨科机器人辅助下行经皮内固定术治疗胸腰椎骨折的置钉准确度及学习曲线分析. 中国脊柱脊髓杂志, 2020, 30(12): 1111-1117.
17.	范明星, 张琦, 赵经纬, 等. 机器人辅助经皮微创单节段胸腰椎骨折内固定术的学习曲线. 中国微创外科杂志, 2019(9): 808-811.
18.	林书, 胡豇, 万仑, 等. “天玑”骨科机器人辅助下经皮椎弓根螺钉植钉安全性评价. 中国修复重建外科杂志, 2021, 35(7): 813-817.
19.	王建, 周跃, 初同伟, 等. 改良内窥镜下行后路腰椎间融合和经皮椎弓根螺钉固定治疗腰椎退变性疾患. 中国脊柱脊髓杂志, 2007, 17(12): 908-912.
20.	Morgenstern R, Morgenstern C. Percutaneous transforaminal lumbar interbody fusion (pTLIF) with a posterolateral approach for the treatment of denegerative disk disease: feasibility and preliminary results. Int J Spine Surg, 2015, 9: 41.
21.	Jacquot F, Gastambide D. Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it?. Int Orthop, 2013, 37(8): 1507-1510.

1. Wearn B, Yue WM, Yew PS, et al. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976), 2009, 34(13): 1385.
2. Lee KH, Yue WM, Yeo W, et al. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J, 2012, 21(11): 2265-2270.
3. 周跃, 王健, 初同伟, 等. 经皮椎弓根螺钉固定、内窥镜下腰椎管减压、椎间融合的临床应用. 中国脊柱脊髓杂志, 2007, 17(5): 333-336.
4. Nowitzke AM. Assessment of the learning curve for lumbar microendoscopic discectomy. Neurosurgery, 2005, 56(4): 755-762.
5. Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2): 98-105.
6. Osman SG. Endoscopic transforaminal decompression, interbody fusion, and percutaneous pedicle screw implantation of the lumbar spine: a case series report. Int J Spine Surg, 2012, 6: 157-166.
7. Wu J, Liu H, Ao S, et al. Percutaneous endoscopic lumbar interbody fusion: technical note and preliminary clinical experience with 2-year follow-up. Biomed Res Int, 2018, 2018: 5806037.
8. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
9. Castro WH, Halm H, Jerosch J, et al. Accuracy of pedicle screw placement in lumbar vertebrae. Spine (Phila Pa 1976), 1996, 21(11): 1320-1324.
10. Amato V, Giannachi L, Irace C, et al. Accuracy of pedicle screw placement in the lumbosacral spine using conventional technique: computed tomography postoperative assessment in 102 consecutive patients. J Neurosurg Spine, 2010, 12(3): 306-313.
11. 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.
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. Barzilay Y, Liebergall M, Fridlander A, et al. Miniature robotic guidance for spine surgery-introduction of a novel system and analysis of challenges encountered during the clinical development phase at two spine centres. Int J Med Robot, 2006, 2(2): 146-153.
14. 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.
15. Cannestra AF. Significant decreased radiation exposure in percutaneous adult degenerative spinal instrumentation with robotic guidance. Spine J, 2014, 14(11): S171.
16. 肖宇, 龙浩, 何祖波, 等. 骨科机器人辅助下行经皮内固定术治疗胸腰椎骨折的置钉准确度及学习曲线分析. 中国脊柱脊髓杂志, 2020, 30(12): 1111-1117.
17. 范明星, 张琦, 赵经纬, 等. 机器人辅助经皮微创单节段胸腰椎骨折内固定术的学习曲线. 中国微创外科杂志, 2019(9): 808-811.
18. 林书, 胡豇, 万仑, 等. “天玑”骨科机器人辅助下经皮椎弓根螺钉植钉安全性评价. 中国修复重建外科杂志, 2021, 35(7): 813-817.
19. 王建, 周跃, 初同伟, 等. 改良内窥镜下行后路腰椎间融合和经皮椎弓根螺钉固定治疗腰椎退变性疾患. 中国脊柱脊髓杂志, 2007, 17(12): 908-912.
20. Morgenstern R, Morgenstern C. Percutaneous transforaminal lumbar interbody fusion (pTLIF) with a posterolateral approach for the treatment of denegerative disk disease: feasibility and preliminary results. Int J Spine Surg, 2015, 9: 41.
21. Jacquot F, Gastambide D. Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it?. Int Orthop, 2013, 37(8): 1507-1510.

West China Medical Journal

Application of robot-assisted endoscopic lumbar decompression and fusion in single segment lumbar fusion surgery

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