The safety of TiRobot-guided percutaneous transpedicular screw implantation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIN Shu , HU Jiang , WAN Lun ,  TANG Liuyi , WANG Yue , YU Yang , ZHANG Wei

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

Corresponding author：

TANG Liuyi, Email: 18981838527@189.cn

Keywords：

Robot; percutaneous screw implantation; thoracolumbar fracture; lumbar degenerative disease; safety

DOI：

10.7507/1002-1892.202103072

Video：

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Objective To evaluate the safety of TiRobot-guided percutaneous transpedicular screw implantation.Methods The medical records of 158 patients with thoracolumbar fractures and lumbar degenerative diseases who underwent percutaneous transpedicular screw implantation were retrospectively analyzed between January 2018 and December 2020. The patients were divided into trial group (TiRobot-guided screw implantation, 86 cases) and control group (fluoroscopy-guided screw implantation, 72 cases). There was no significant difference in gender, age, pathology, lesion segment, and the average number of screw implantation per case (P>0.05). The operation time, fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency were compared between the two groups. One day postoperatively, the convergence angle was measured and the penetration of the pedicle cortex was evaluated according to Gertzbein-Robbins classification standard.Results The operation time, fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency of the trial group were significantly lesser than those of control group (P<0.05).One day postoperatively, the convergence angle of trial group was (21.10±4.08)°, which was significantly larger than control group (19.17±3.48)° (t=6.810, P=0.000). According to the Gertzbein-Robbins classification standard, 446 pedicle screws were implanted in trial group, trajectories were grade A in 377 screws, grade B in 46 screws, grade C in 23 screws, and the accuracy of screw implantation was 94.8%; 380 pedicle screws were implanted in control group, trajectories were grade A in 283 screws, grade B in 45 screws, grade C in 44 screws, grade D in 6 screws, grade E in 2 screws, and the accuracy of screw implantation was 86.3%. There was significant difference in the accuracy of screw implantation between the two groups (χ²=25.950, P=0.000). Conclusion Compared with traditional percutaneous transpedicular screw implantation, TiRobot-guided percutaneous transpedicular screw implantation can improve the accuracy of screw implantation, reduce radiation exposure, and improve surgical safety, which has a good application prospect.

Citation： LIN Shu, HU Jiang, WAN Lun, TANG Liuyi, WANG Yue, YU Yang, ZHANG Wei. The safety of TiRobot-guided percutaneous transpedicular screw implantation. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(7): 813-817. doi: 10.7507/1002-1892.202103072 Copy

1.	杨佳宁, 赵胜军, 赵丽丽, 等. 微创通道下 MIS-TLIF 联合经皮椎弓根螺钉治疗腰椎滑脱症的临床疗效观察. 中国矫形外科杂志, 2019, 27(3): 273-276.
2.	祝乃强, 侯静怡, 马桂云, 等. 经皮椎弓根螺钉内固定治疗胸腰椎骨折. 中国矫形外科杂志, 2019, 18(9): 1663-1668.
3.	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, 19(9): 808-811.
4.	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.
5.	曹旭含, 白子兴, 孙承颐, 等. 机器人在骨科手术中应用的可靠性与提升空间. 中国组织工程研究, 2020, 24(9): 1416-1421.
6.	高阳阳, 车先达, 韩鹏飞, 等. 透视引导与机器人辅助椎弓根置钉效果的荟萃分析. 中国组织工程研究, 2020, 24(3): 446-452.
7.	张在田, 张绪华, 卫志华, 等. 机器人辅助与徒手单侧穿刺椎体成形术治疗骨质疏松性椎体压缩骨折疗效的比较. 骨科临床与研究杂志, 2018, 3(4): 205-208.
8.	林书, 胡豇, 万仑, 等. 骨科机器人辅助经皮椎体后凸成形治疗多节段脊柱转移瘤. 中国组织工程研究, 2020, 24(33): 5249-5254.
9.	茅剑平, 张琦, 范明星, 等. 机器人辅助与徒手置入椎弓根螺钉在经椎间孔腰椎椎间融合术中的对比研究. 中国微创外科杂志, 2019, 19(6): 481-484, 489.
10.	Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
11.	林书, 胡豇, 万仑, 等. 机器人与透视辅助经皮椎弓根螺钉置入的比较. 中国矫形外科杂志, 2020, 28(20): 1830-1834.
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.	Pechlivanis I, Kiriyanthan G, Engelhardt M, et al. Percutaneous placement of pedicle screws in the lumbar spine using a bone mounted miniature robotic system: first experiences and accuracy of screw placement. Spine (Phila Pa 1976), 2009, 34(4): 392-398.
14.	Macke JJ, Woo R, Varich L. Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population. J Robot Surg, 2016, 10(2): 145-150.
15.	Onen MR, Simsek M, Naderi S. Robotic spine surgery: a preliminary report. Turk Neurosurg, 2014, 24(4): 512-518.
16.	Schatlo B, Martinez R, Alaid A, et al. Unskilled unawareness and the learning curve in robotic spine surgery. Acta Neurochir (Wien), 2015, 157(10): 1819-1823.
17.	Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
18.	Hyun SJ, Kim KJ, Jahng TA, et al. Minimally invasive, robotic versus open fluoroscopic-guided spinal instrumented fusions—a randomized, controlled trial. Spine (Phila Pa 1976), 2017, 42(6): 353-358.
19.	Kim HJ, Jung WI, Chang BS, et al. A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery. Int J Med Robot, 2017, 13(3). doi: 10.1002/rcs.1779.
20.	Roser F, Tatagiba M, Maier G. Spinal robotics: current applications and future perspectives. Neurosurgery, 2013, 72 Suppl 1: 12-18.
21.	Keric N, Eum DJ, Afghanyar F, et al. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis. J Robot Surg, 2017, 11(1): 17-25.
22.	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. doi: 10.3171/2017.3.FOCUS179.
23.	Lonjon N, Chan-Seng E, Costalat V, et al. Robot-assisted spine surgery: feasibility study through a prospective case-matched analysis. Eur Spine J, 2016, 25(3): 947-955.
24.	Ringel F, Stüer C, Reinke A, et al. Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: a prospective randomized comparison to conventional freehand screw implantation. Spine (Phila Pa 1976), 2012, 37(8): E496-501.
25.	Zhang Q, Xu YF, Tian W, et al. Comparison of superior-level facet joint violations between robot-assisted percutaneous pedicle screw placement and conventional open fluoroscopic-guided pedicle screw placement. Orthop Surg, 2019, 11(5): 850-856.
26.	Feng S, Tian W, Sun Y, et al. Effect of robot-assisted surgery on lumbar pedicle screw internal fixation in patients with osteoporosis. World Neurosurg, 2019, 125: e1057-e1062.
27.	Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019. doi: 10.3171/2018.10.SPINE18487.
28.	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.
29.	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.
30.	Schizas C, Thein E, Kwiatkowski B, et al. Pedicle screw insertion: robotic assistance versus conventional C-arm fluoroscopy. Acta Orthop Belg, 2012, 78(2): 240-245.
31.	Solomiichuk V, Fleischhammer J, Molliqaj G, et al. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison. Neurosurg Focus, 2017, 42(5): E13.
32.	徐鹏, 葛鹏, 章仁杰, 等. 机器人辅助下椎弓根螺钉固定治疗胸腰椎骨折. 颈腰痛杂志, 2018, 39(6): 687-690.
33.	陈龙, 海涌, 关立, 等. 机器人辅助置入与徒手置入椎弓根螺钉的对比研究. 中国骨与关节杂志, 2017, 6(10): 730-736.
34.	李浩, 方宣城, 邱新建, 等. 机器人辅助与 “C” 型臂 X 线机透视经皮微创椎弓根螺钉内固定治疗胸腰椎骨折疗效的比较. 骨科临床与研究杂志, 2018, 3(4): 200-204.

1. 杨佳宁, 赵胜军, 赵丽丽, 等. 微创通道下 MIS-TLIF 联合经皮椎弓根螺钉治疗腰椎滑脱症的临床疗效观察. 中国矫形外科杂志, 2019, 27(3): 273-276.
2. 祝乃强, 侯静怡, 马桂云, 等. 经皮椎弓根螺钉内固定治疗胸腰椎骨折. 中国矫形外科杂志, 2019, 18(9): 1663-1668.
3. 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, 19(9): 808-811.
4. 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.
5. 曹旭含, 白子兴, 孙承颐, 等. 机器人在骨科手术中应用的可靠性与提升空间. 中国组织工程研究, 2020, 24(9): 1416-1421.
6. 高阳阳, 车先达, 韩鹏飞, 等. 透视引导与机器人辅助椎弓根置钉效果的荟萃分析. 中国组织工程研究, 2020, 24(3): 446-452.
7. 张在田, 张绪华, 卫志华, 等. 机器人辅助与徒手单侧穿刺椎体成形术治疗骨质疏松性椎体压缩骨折疗效的比较. 骨科临床与研究杂志, 2018, 3(4): 205-208.
8. 林书, 胡豇, 万仑, 等. 骨科机器人辅助经皮椎体后凸成形治疗多节段脊柱转移瘤. 中国组织工程研究, 2020, 24(33): 5249-5254.
9. 茅剑平, 张琦, 范明星, 等. 机器人辅助与徒手置入椎弓根螺钉在经椎间孔腰椎椎间融合术中的对比研究. 中国微创外科杂志, 2019, 19(6): 481-484, 489.
10. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
11. 林书, 胡豇, 万仑, 等. 机器人与透视辅助经皮椎弓根螺钉置入的比较. 中国矫形外科杂志, 2020, 28(20): 1830-1834.
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. Pechlivanis I, Kiriyanthan G, Engelhardt M, et al. Percutaneous placement of pedicle screws in the lumbar spine using a bone mounted miniature robotic system: first experiences and accuracy of screw placement. Spine (Phila Pa 1976), 2009, 34(4): 392-398.
14. Macke JJ, Woo R, Varich L. Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population. J Robot Surg, 2016, 10(2): 145-150.
15. Onen MR, Simsek M, Naderi S. Robotic spine surgery: a preliminary report. Turk Neurosurg, 2014, 24(4): 512-518.
16. Schatlo B, Martinez R, Alaid A, et al. Unskilled unawareness and the learning curve in robotic spine surgery. Acta Neurochir (Wien), 2015, 157(10): 1819-1823.
17. Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
18. Hyun SJ, Kim KJ, Jahng TA, et al. Minimally invasive, robotic versus open fluoroscopic-guided spinal instrumented fusions—a randomized, controlled trial. Spine (Phila Pa 1976), 2017, 42(6): 353-358.
19. Kim HJ, Jung WI, Chang BS, et al. A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery. Int J Med Robot, 2017, 13(3). doi: 10.1002/rcs.1779.
20. Roser F, Tatagiba M, Maier G. Spinal robotics: current applications and future perspectives. Neurosurgery, 2013, 72 Suppl 1: 12-18.
21. Keric N, Eum DJ, Afghanyar F, et al. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis. J Robot Surg, 2017, 11(1): 17-25.
22. 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. doi: 10.3171/2017.3.FOCUS179.
23. Lonjon N, Chan-Seng E, Costalat V, et al. Robot-assisted spine surgery: feasibility study through a prospective case-matched analysis. Eur Spine J, 2016, 25(3): 947-955.
24. Ringel F, Stüer C, Reinke A, et al. Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: a prospective randomized comparison to conventional freehand screw implantation. Spine (Phila Pa 1976), 2012, 37(8): E496-501.
25. Zhang Q, Xu YF, Tian W, et al. Comparison of superior-level facet joint violations between robot-assisted percutaneous pedicle screw placement and conventional open fluoroscopic-guided pedicle screw placement. Orthop Surg, 2019, 11(5): 850-856.
26. Feng S, Tian W, Sun Y, et al. Effect of robot-assisted surgery on lumbar pedicle screw internal fixation in patients with osteoporosis. World Neurosurg, 2019, 125: e1057-e1062.
27. Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019. doi: 10.3171/2018.10.SPINE18487.
28. 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.
29. 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.
30. Schizas C, Thein E, Kwiatkowski B, et al. Pedicle screw insertion: robotic assistance versus conventional C-arm fluoroscopy. Acta Orthop Belg, 2012, 78(2): 240-245.
31. Solomiichuk V, Fleischhammer J, Molliqaj G, et al. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison. Neurosurg Focus, 2017, 42(5): E13.
32. 徐鹏, 葛鹏, 章仁杰, 等. 机器人辅助下椎弓根螺钉固定治疗胸腰椎骨折. 颈腰痛杂志, 2018, 39(6): 687-690.
33. 陈龙, 海涌, 关立, 等. 机器人辅助置入与徒手置入椎弓根螺钉的对比研究. 中国骨与关节杂志, 2017, 6(10): 730-736.
34. 李浩, 方宣城, 邱新建, 等. 机器人辅助与 “C” 型臂 X 线机透视经皮微创椎弓根螺钉内固定治疗胸腰椎骨折疗效的比较. 骨科临床与研究杂志, 2018, 3(4): 200-204.

Chinese Journal of Reparative and Reconstructive Surgery

The safety of TiRobot-guided percutaneous transpedicular screw implantation

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