A comparative study of spinal robot-assisted and traditional fluoroscopy-assisted percutaneous reduction and internal fixation for single-level thoracolumbar fractures without neurological symptoms_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TIAN Ye ^1,2 , ZHANG Jianan ² , CHEN Hao ² , DING Keyuan ² , LIU Tuanjiang ² , HUANG Dageng ² ,  HAO Dingjun ²

1. Xi’an Medical University, Xi’an Shaanxi, 710068, P.R.China;
2. Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

HAO Dingjun, Email: haodingjun@126.com

Keywords：

Spinal robot; fluoroscopy; percutaneous reduction and internal fixation; thoracolumbar fracture; screw placement; accuracy

DOI：

10.7507/1002-1892.201905057

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Objective To compare the effectiveness and screw planting accuracy of percutaneous reduction and internal fixation with robot and traditional fluoroscopy-assisted in the treatment of single-level thoracolumbar fractures without neurological symptoms.Methods The clinical data of 58 patients with single-level thoracolumbar fractures without neurological symptoms between December 2016 and January 2018 were retrospectively analysed. According to different surgical methods, the patients were divided into group A (28 cases underwent robot-assisted percutaneous reduction and internal fixation) and group B (30 cases underwent fluoroscopy-assisted percutaneous reduction and internal fixation). There was no neurological symptoms, other fractures or organ injuries in the two groups. There was no significant difference in general data of age, gender, fracture location, AO classification, time from injury to surgery, and preoperative vertebral anterior height ratio, sagittal Cobb angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI) score between the two groups (P>0.05). The screw placement time, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization time, operation cost, postoperative complications, VAS score, ODI score, anterior vertebral height ratio, and sagittal Cobb angle before operation, at 3 days, 6 months after operation, and at last follow-up were recorded and compared between the two groups. The accuracy of the pedicle screw placement was evaluated by Neo’s criteria.Results The screw placement time, operation time, and intraoperative fluoroscopy frequency of group A were significantly less than those of group B, and the operation cost was significantly higher than that of group B (P<0.05). But there was no significant difference in intraoperative blood loss and hospitalization time between the two groups (P>0.05). Both groups were followed up 12-24 months, with an average of 15.2 months. The accuracy rate of screw placement in groups A and B was 93.75% (150/160) and 84.71% (144/170), respectively, and the difference was significant (χ²=5.820, P=0.008). Except for 1 case of postoperative superficial infection in group A and wound healing after dressing change, there was no complication such as neurovascular injury, screw loosening and fracture in both groups, and there was no significant difference in the incidence of complications between the two groups (χ²=0.625, P=0.547). The anterior vertebral height ratio, sagittal Cobb angle, VAS score, and ODI score of the two groups were significantly improved (P<0.05); there was no significant difference between the two groups at all time points after operation (P>0.05).Conclusion The spinal robot and traditional fluoroscopy-assisted percutaneous reduction and internal fixation can both achieve satisfactory effectiveness in the treatment of single-level thoracolumbar fractures without neurological symptoms. However, the former has higher accuracy, fewer fluoroscopy times, shorter time of screw placement, and lower technical requirements for the operator. It has wide application potential.

Citation： TIAN Ye, ZHANG Jianan, CHEN Hao, DING Keyuan, LIU Tuanjiang, HUANG Dageng, HAO Dingjun. A comparative study of spinal robot-assisted and traditional fluoroscopy-assisted percutaneous reduction and internal fixation for single-level thoracolumbar fractures without neurological symptoms. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(1): 69-75. doi: 10.7507/1002-1892.201905057 Copy

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2.	Neo M, Sakamoto T, Fujibayashi S, et al. The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine (Phila Pa 1976), 2005, 30(24): 2800-2805.
3.	Wang H, Zhou Y, Li C, et al. Comparison of open versus percutaneous pedicle screw fixation using the sextant system in the treatment of traumatic thoracolumbar fractures. Clin Spine Surg, 2017, 30(3): E239-E246.
4.	Sun XY, Zhang XN, Hai Y. Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: a meta-analysis. Eur Spine J, 2017, 26(5): 1418-1431.
5.	Arts MP, Nieborg A, Brand R, et al. Serum creatine phosphokinase as an indicator of muscle injury after various spinal and nonspinal surgical procedures. J Neurosurg Spine, 2007, 7(3): 282-286.
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7.	Lehmann W, Ushmaev A, Ruecker A, et al. Comparison of open versus percutaneous pedicle screw insertion in a sheep model. Eur Spine J, 2008, 17(6): 857-863.
8.	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.
9.	Keric N, Doenitz C, Haj A, et al. Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws. Neurosurg Focus, 2017, 42(5): E11.
10.	Johnson N. Imaging, navigation, and robotics in spine surgery. Spine (Phila Pa 1976), 2016, 41(Suppl 7): S32.
11.	Yang M, Zhao Q, Hao D, et al. Comparison of clinical results between novel percutaneous pedicle screw and traditional open pedicle screw fixation for thoracolumbar fractures without neurological deficit. Int Orthop, 2019, 43(7): 1749-1754.
12.	van Dijk JD, van den Ende RP, Stramigioli S, et al. Clinical pedicle screw accuracy and deviation from planning in robot-guided spine surgery: robot-guided pedicle screw accuracy. Spine (Phila Pa 1976), 2015, 40(17): E986-991.
13.	Tian W, Fan MX, Liu YJ. Robot-assisted percutaneous pedicle screw placement using three-dimensional fluoroscopy: a preliminary clinical study. Chin Med J (Engl), 2017, 130(13): 1617-1618.
14.	Roser F, Tatagiba M, Maier G. Spinal robotics: current applications and future perspectives. Neurosurgery, 2013, 72(Suppl 1): 12-18.
15.	Babu R, Park JG, Mehta AI, et al. Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement. Neurosurgery, 2012, 71(5): 962-970.
16.	Jones-Quaidoo SM, Djurasovic M, Owens RK 2nd, et al. Superior articulating facet violation: percutaneous versus open techniques. J Neurosurg Spine, 2013, 18(6): 593-597.
17.	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.
18.	Archavlis E, Amr N, Kantelhardt SR, et al. Rates of upper facet joint violation in minimally invasive percutaneous and open instrumentation: a comparative cohort study of different insertion techniques. J Neurol Surg A Cent Eur Neurosurg, 2018, 79(1): 1-8.
19.	杨俊松, 郝定均, 刘团江, 等. 脊柱机器人与透视辅助下经皮植钉治疗腰椎滑脱症中植钉精度的对比研究. 中国修复重建外科杂志, 2018, 32(11): 1371-1376.

1. Vanek P, Bradac O, Konopkova R, et al. Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up. J Neurosurg Spine, 2014, 20(2): 150-156.
2. Neo M, Sakamoto T, Fujibayashi S, et al. The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine (Phila Pa 1976), 2005, 30(24): 2800-2805.
3. Wang H, Zhou Y, Li C, et al. Comparison of open versus percutaneous pedicle screw fixation using the sextant system in the treatment of traumatic thoracolumbar fractures. Clin Spine Surg, 2017, 30(3): E239-E246.
4. Sun XY, Zhang XN, Hai Y. Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: a meta-analysis. Eur Spine J, 2017, 26(5): 1418-1431.
5. Arts MP, Nieborg A, Brand R, et al. Serum creatine phosphokinase as an indicator of muscle injury after various spinal and nonspinal surgical procedures. J Neurosurg Spine, 2007, 7(3): 282-286.
6. Kumbhare D, Parkinson W, Dunlop B. Validity of serum creatine kinase as a measure of muscle injury produced by lumbar surgery. J Spinal Disord Tech, 2008, 21(1): 49-54.
7. Lehmann W, Ushmaev A, Ruecker A, et al. Comparison of open versus percutaneous pedicle screw insertion in a sheep model. Eur Spine J, 2008, 17(6): 857-863.
8. 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.
9. Keric N, Doenitz C, Haj A, et al. Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws. Neurosurg Focus, 2017, 42(5): E11.
10. Johnson N. Imaging, navigation, and robotics in spine surgery. Spine (Phila Pa 1976), 2016, 41(Suppl 7): S32.
11. Yang M, Zhao Q, Hao D, et al. Comparison of clinical results between novel percutaneous pedicle screw and traditional open pedicle screw fixation for thoracolumbar fractures without neurological deficit. Int Orthop, 2019, 43(7): 1749-1754.
12. van Dijk JD, van den Ende RP, Stramigioli S, et al. Clinical pedicle screw accuracy and deviation from planning in robot-guided spine surgery: robot-guided pedicle screw accuracy. Spine (Phila Pa 1976), 2015, 40(17): E986-991.
13. Tian W, Fan MX, Liu YJ. Robot-assisted percutaneous pedicle screw placement using three-dimensional fluoroscopy: a preliminary clinical study. Chin Med J (Engl), 2017, 130(13): 1617-1618.
14. Roser F, Tatagiba M, Maier G. Spinal robotics: current applications and future perspectives. Neurosurgery, 2013, 72(Suppl 1): 12-18.
15. Babu R, Park JG, Mehta AI, et al. Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement. Neurosurgery, 2012, 71(5): 962-970.
16. Jones-Quaidoo SM, Djurasovic M, Owens RK 2nd, et al. Superior articulating facet violation: percutaneous versus open techniques. J Neurosurg Spine, 2013, 18(6): 593-597.
17. 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.
18. Archavlis E, Amr N, Kantelhardt SR, et al. Rates of upper facet joint violation in minimally invasive percutaneous and open instrumentation: a comparative cohort study of different insertion techniques. J Neurol Surg A Cent Eur Neurosurg, 2018, 79(1): 1-8.
19. 杨俊松, 郝定均, 刘团江, 等. 脊柱机器人与透视辅助下经皮植钉治疗腰椎滑脱症中植钉精度的对比研究. 中国修复重建外科杂志, 2018, 32(11): 1371-1376.

Chinese Journal of Reparative and Reconstructive Surgery

A comparative study of spinal robot-assisted and traditional fluoroscopy-assisted percutaneous reduction and internal fixation for single-level thoracolumbar fractures without neurological symptoms

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