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Yuan S, Chen R, Zang L, Wang A, Fan N, Du P, Xi Y, Wang T. Development of a software system for surgical robots based on multimodal image fusion: study protocol. Front Surg 2024; 11:1389244. [PMID: 38903864 PMCID: PMC11187239 DOI: 10.3389/fsurg.2024.1389244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/29/2024] [Indexed: 06/22/2024] Open
Abstract
Background Surgical robots are gaining increasing popularity because of their capability to improve the precision of pedicle screw placement. However, current surgical robots rely on unimodal computed tomography (CT) images as baseline images, limiting their visualization to vertebral bone structures and excluding soft tissue structures such as intervertebral discs and nerves. This inherent limitation significantly restricts the applicability of surgical robots. To address this issue and further enhance the safety and accuracy of robot-assisted pedicle screw placement, this study will develop a software system for surgical robots based on multimodal image fusion. Such a system can extend the application range of surgical robots, such as surgical channel establishment, nerve decompression, and other related operations. Methods Initially, imaging data of the patients included in the study are collected. Professional workstations are employed to establish, train, validate, and optimize algorithms for vertebral bone segmentation in CT and magnetic resonance (MR) images, intervertebral disc segmentation in MR images, nerve segmentation in MR images, and registration fusion of CT and MR images. Subsequently, a spine application model containing independent modules for vertebrae, intervertebral discs, and nerves is constructed, and a software system for surgical robots based on multimodal image fusion is designed. Finally, the software system is clinically validated. Discussion We will develop a software system based on multimodal image fusion for surgical robots, which can be applied to surgical access establishment, nerve decompression, and other operations not only for robot-assisted nail placement. The development of this software system is important. First, it can improve the accuracy of pedicle screw placement, percutaneous vertebroplasty, percutaneous kyphoplasty, and other surgeries. Second, it can reduce the number of fluoroscopies, shorten the operation time, and reduce surgical complications. In addition, it would be helpful to expand the application range of surgical robots by providing key imaging data for surgical robots to realize surgical channel establishment, nerve decompression, and other operations.
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Affiliation(s)
| | | | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Liu X, Zhou Q, Sun Z, Tian J, Wang H. Clinical effects of cocktail injection on the thoracolumbar fascia injury during percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a single-center, retrospective case-control study. BMC Musculoskelet Disord 2024; 25:18. [PMID: 38166954 PMCID: PMC10759409 DOI: 10.1186/s12891-023-07130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Nowadays, there is a lack of effective intraoperative treatment for thoracolumbar fascia injury (TFI) of osteoporotic vertebral compression fractures (OVCFs), which may lead to postoperative residual pain. We aimed to evaluate the clinical effects of cocktail injection on the TFI during percutaneous vertebroplasty (PVP) for OVCFs. METHODS A retrospective study of OVCFs with TFI underwent PVP with cocktail injection (Cocktail group, 58 cases) or PVP (Routine group, 64 cases) was conducted. The surgical outcomes, visual analog scale (VAS) score, oswestry disability index (ODI), incidence of residual pain at 1 day and 7 days postoperatively, the rate and duration of taking painkillers during 7 days postoperatively after PVP were compared between them. RESULTS No differences in baseline data, volume of bone cement injected and bone cement leakage were observed between the two groups, while the operation time of the routine group (44.3 ± 7.8 min) was less than that (47.5 ± 9.1 min) of the cocktail group (P < 0.05). However, the VAS scores (2.4 ± 0.8, 2.2 ± 0.7), ODI (25.2 ± 4.2, 22.3 ± 2.9), the incidence of residual pain (8.6%, 3.4%) at 1 and 7 days postoperatively, the rate (6.9%) and duration ( 2.5 ± 0.6 ) of taking painkillers during 7 days postoperatively in the cocktail group were better than those (3.4 ± 1.0, 2.9 ± 0.7, 34.1 ± 4.7, 28.6 ± 3.6, 23.4%, 15.6%, 28.1%, 4.2 ± 1.4) in the routine group (P < 0.05), respectively. CONCLUSION PVP combined with cocktail injection increased the operation time in the treatment of OVCFs with TFI, but it can more effectively relieve pain, reduce the risk of residual pain at 1 day and 7 days postoperatively, and decrease the use and duration of taking painkillers.
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Affiliation(s)
- Xiaolei Liu
- Department of Orthopedics, the Fourth Affiliated Hospital of Nanjing Medical University, Nanpu road 298#, Jiangbei new District, Nanjing, 210000, China
| | - Qinqin Zhou
- Department of Anesthesiology, the BenQ Hospital affiliated to Nanjing Medical University, Nanjing, 210000, China
| | - Zhongyi Sun
- Department of Orthopedics, the BenQ Hospital affiliated to Nanjing Medical University, Nanjing, 210000, China
| | - Jiwei Tian
- Department of Orthopedics, the BenQ Hospital affiliated to Nanjing Medical University, Nanjing, 210000, China.
| | - Haibin Wang
- Department of Orthopedics, the Fourth Affiliated Hospital of Nanjing Medical University, Nanpu road 298#, Jiangbei new District, Nanjing, 210000, China.
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Wang J, Miao J, Zhan Y, Duan Y, Wang Y, Hao D, Wang B. Spine Surgical Robotics: Current Status and Recent Clinical Applications. Neurospine 2023; 20:1256-1271. [PMID: 38171293 PMCID: PMC10762389 DOI: 10.14245/ns.2346610.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 01/05/2024] Open
Abstract
With the development of artificial intelligence and the further deepening of medical-engineering integration, spine surgical robot-assisted (RA) technique has made significant progress and its applicability in clinical practice is constantly expanding in recent years. In this review, we have systematically summarized the majority of literature related to spine surgical robots in the past decade, and not only classified robots accordingly, but also summarized the latest research progress in RA technique for screw placement such as cervical, thoracic, and lumbar pedicle screws, cortical bone trajectory screws, cervical lateral mass screws, and S2 sacroiliac screws; guiding targeted puncture and placement of endoscope via the intervertebral foramen; complete resection of spinal tumor tissue; and decompressive laminectomy. In addition, this report also provides a detailed evaluation of RA technique's advantages and disadvantages, and clarifies the accuracy, safety, and practicality of RA technique. We consider that this review can help clinical physicians further understand and familiarize the current clinical application status of spine surgical robots, thereby promoting the continuous improvement and popularization of RA technique, and ultimately benefiting numerous patients.
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Affiliation(s)
- Jiangtao Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Medical School of Yan’an University, Yan’an, China
| | - Junxian Miao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Shaanxi University of Chinese Medicine, Xi’an, China
| | - Yi Zhan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Shaanxi University of Chinese Medicine, Xi’an, China
| | - Yongchao Duan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Department of Intraoperative Imaging, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yuanshun Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Department of Orthopedics, The Third People’s Hospital of Xining, Qinghai, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Biao Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
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Chang Y, Chen WC, Chi KY, Huang APH, Jhang SW, Sun LW, Chen CM. Robot-Assisted Kyphoplasty versus Fluoroscopy-Assisted Kyphoplasty: A Meta-Analysis of Postoperative Outcomes. Medicina (B Aires) 2023; 59:medicina59040662. [PMID: 37109620 PMCID: PMC10147052 DOI: 10.3390/medicina59040662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Osteoporotic vertebral compression fractures are the most common manifestation of osteoporosis. Percutaneous kyphoplasty (PKP) can lead to both pain improvement and correction of kyphosis secondary to collapsed vertebral bodies. Robot-assisted (RA) PKP has been reported to provide better vertebral body fracture correction than conventional fluoroscopy-assisted (FA) PKP. The aim of this meta-analysis is to compare clinical outcomes of RA PKP versus FA PKP. The Pubmed, Embase, and MEDLINE electronic databases were searched from January 1900 to December 2022, with no language restrictions for relevant articles. We extracted the preoperative and postoperative mean pain score and standard deviation from the included studies and pooled them using an inverse variance method. Statistical analyses were performed using functions available in the metafor package in R software. The results of this meta-analysis were summarized with weighted mean differences (WMDs). Our search strategy identified 181 references from the Pubmed, Embase, and MEDLINE electronic databases. We excluded duplicates and irrelevant references, after screening titles and abstracts. The remaining 12 studies were retrieved for full-text review, and, finally, we included five retrospective cohort studies from 2015 to 2021, comprising 223 patients undergoing RA PKP and 246 patients undergoing FA PKP. No difference was found in subgroup analysis based on the timing of postoperative pain assessment, despite the overall estimate of postoperative pain indicating a significant difference between the RA PKP and FA PKP groups (WMD, −0.22; 95% CI, −0.39 to −0.05). The long-term pain assessment revealed a significantly lower VAS in the RA PKP group than the FA PKP group at six months postoperatively (WMD, −0.15; 95% CI, −0.30 to −0.01), but no difference between the subgroups at three (WMD, 0.06; 95% CI, −0.41 to −0.54) and twelve months (WMD, −0.10; 95% CI, −0.50 to 0.30) postoperatively. Our meta-analysis revealed no significant difference in postoperative pain between RA PKP and FA PKP. Patients undergoing RA PKP had better pain improvement compared to FA PKP at 6 months postoperatively. However, further studies focusing on long-term outcomes in patients undergoing RA PKP are warranted to clarify its benefit, given the small number of included studies.
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Affiliation(s)
- Yu Chang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Wei-Cheng Chen
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan;
| | - Kuan-Yu Chi
- Department of Education, Center for Evidence-Based Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan;
| | - Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100, Taiwan;
| | - Shang-Wun Jhang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan; (S.-W.J.); (L.-W.S.)
| | - Li-Wei Sun
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan; (S.-W.J.); (L.-W.S.)
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan; (S.-W.J.); (L.-W.S.)
- College of Nursing and Health Sciences, Dayeh University, Changhua 515, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung 433, Taiwan
- Correspondence:
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