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Wu J, Fan M, He D, Wei Y, Duan F, Jiang X, Tian W. Accuracy and clinical characteristics of robot-assisted cervical spine surgery: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06179-4. [PMID: 38613575 DOI: 10.1007/s00264-024-06179-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE To evaluate the accuracy and feasibility of robot-assisted cervical screw placement and factors that may affect the accuracy. METHODS A comprehensive search was made on PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang Med for the selection of potential eligible literature. The outcomes were evaluated in terms of the relative risk (RR) or standardized mean difference (MD) and corresponding 95% confidence interval (CI). Subgroup analyses of the accuracy of screw placement at different cervical segments and with different screw placement approaches were performed. A comparison was made between robotic navigation and conventional freehand cervical screw placement. RESULTS Six comparative cohort studies and five case series studies with 337 patients and 1342 cervical screws were included in this study. The perfect accuracy was 86% (95% CI, 82-89%) and the clinically acceptable rate was 98% (95% CI, 95-99%) in robot-assisted cervical screw placement. The perfect accuracy of robot-assisted C1 lateral mass screw placement was the highest (96%), followed by C6-7 pedicle screw placement (93%) and C2 pedicle screw placement (86%), and the lowest was C3-5 pedicle screw placement (75%). The open approach had a higher perfect accuracy than the percutaneous/intermuscular approach (91% vs 83%). Compared with conventional freehand cervical screw placement, robot-assisted cervical screw placement had a higher accuracy, a lower incidence of perioperative complications, and less intraoperative blood loss. CONCLUSION With good collaboration between the operator and the robot, robot-assisted cervical screw placement is accurate and feasible. Robot-assisted cervical screw placement has a promising prospect.
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Affiliation(s)
- Jiayuan Wu
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Da He
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
| | - Yi Wei
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Fangfang Duan
- Epidemiological Research Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Xieyuan Jiang
- Trauma Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
- Beijing Jishuitan Orthopaedic Robot Engineering Research Center Co., Ltd, Beijing, 100035, China
| | - Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
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Zhou LP, Zhang RJ, Zhang WK, Kang L, Li KX, Zhang HQ, Jia CY, Zhang YS, Shen CL. Clinical application of spinal robot in cervical spine surgery: safety and accuracy of posterior pedicle screw placement in comparison with conventional freehand methods. Neurosurg Rev 2023; 46:118. [PMID: 37166553 DOI: 10.1007/s10143-023-02027-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/18/2023] [Accepted: 05/06/2023] [Indexed: 05/12/2023]
Abstract
The novel robot-assisted (RA) technique has been utilized increasingly to improve the accuracy of cervical pedicle screw placement. Although the clinical application of the RA technique has been investigated in several case series and comparative studies, the superiority and safety of RA over conventional freehand (FH) methods remain controversial. Meanwhile, the intra-pedicular accuracy of the two methods has not been compared for patients with cervical traumatic conditions. This study aimed to compare the rate and risk factors of intra-pedicular accuracy of RA versus the conventional FH approach for posterior pedicle screw placement in cervical traumatic diseases. A total of 52 patients with cervical traumatic diseases who received cervical screw placement using RA (26 patients) and FH (26 patients) techniques were retrospectively included. The primary outcome was the intra-pedicular accuracy of cervical pedicle screw placement according to the Gertzbin-Robbins scale. Secondary outcome parameters included surgical time, intraoperative blood loss, postoperative drainage, postoperative hospital stay, and complications. Moreover, the risk factors that possibly affected intra-pedicular accuracy were assessed using univariate analyses. Out of 52 screws inserted using the RA method, 43 screws (82.7%) were classified as grade A, with the remaining 7 (13.5%) and 2 (3.8%) screws classified as grades B and C. In the FH cohort, 60.8% of the 79 screws were graded A, with the remaining screws graded B (21, 26.6%), C (8, 10.1%), and D (2, 2.5%). The RA technique showed a significantly higher rate of optimal intra-pedicular accuracy than the FH method (P = 0.008), but there was no significant difference between the two groups in terms of clinically acceptable accuracy (P = 0.161). Besides, the RA technique showed remarkably longer surgery time, less postoperative drainage, shorter postoperative hospital stay, and equivalent intraoperative blood loss and complications than the FH technique. Furthermore, the univariate analyses showed that severe obliquity of the lateral atlantoaxial joint in the coronal plane (P = 0.003) and shorter width of the lateral mass at the inferior margin of the posterior arch (P = 0.014) were risk factors related to the inaccuracy of C1 screw placement. The diagnosis of HRVA (P < 0.001), severe obliquity of the lateral atlantoaxial joint in the coronal plane (P < 0.001), short pedicle width (P < 0.001), and short pedicle height (P < 0.001) were risk factors related to the inaccuracy of C2 screw placement. RA cervical pedicle screw placement was associated with a higher rate of optimal intra-pedicular accuracy to the FH technique for patients with cervical traumatic conditions. The severe obliquity of the lateral atlantoaxial joint in the coronal plane independently contributed to high rates of the inaccuracy of C1 and C2 screw placements. RA pedicle screw placement is safe and useful for cervical traumatic surgery.
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Affiliation(s)
- Lu-Ping Zhou
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Ren-Jie Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Wen-Kui Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Liang Kang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Kai-Xuan Li
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Hua-Qing Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Chong-Yu Jia
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Yin-Shun Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
| | - Cai-Liang Shen
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
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Niu HG, Zhang JJ, Tao H, Liu C, Zhou LP, Yang K, Cao Y, Li W, Shen CL, Zhang YS. Robot-Assisted Percutaneous Lag Screw Osteosynthesis for C1 Lateral Mass Fractures: Case Series and Technical Note. World Neurosurg 2023; 172:66-70. [PMID: 36739898 DOI: 10.1016/j.wneu.2023.01.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND C1 lateral mass fractures (LMF) cause abnormal alignment of the upper cervical joints. Conservatively treated cases can develop into late cock-robin junction, requiring a reconstructive surgical procedure of the occipitocervical junction. Partial coronal C1 LMF could be effectively fixed with lag screws. Navigation and robot-assisted techniques have made percutaneous fixation possible and are gradually being used in the upper cervical spine. METHODS Five consecutive patients with C1 LMF who underwent percutaneous lag screw osteosynthesis under the guidance of a new robotic system were reviewed retrospectively. Preoperative and postoperative computed tomography scans were used to specify the fracture types and to assess the efficacy of fracture reduction. The medical records were reviewed. RESULTS Among the 5 patients, 4 underwent percutaneous lag screw reduction and fixation with the assistance of the robotic system through a posterior approach and 1 patient underwent a transoral approach. No intraoperative complications, such as screw malposition, neurologic deficit, and vertebral artery injury, occurred. Satisfactory fracture reduction and bone healing were achieved at postoperative follow-up. CONCLUSIONS Robot-assisted percutaneous lag screw osteosynthesis is a viable option for C1 LMF. Different approaches can be selected according to the distribution of the fracture lines. With the posterior approach, the guidewire tends to deviate from the entry point because of skiving, and the technical problems need to be further solved. Screw implant by a transoral approach is comparatively easy to achieve, but the possibly of infection exists and should be monitored.
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Affiliation(s)
- He-Gang Niu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
| | - Jing-Jing Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
| | - Hui Tao
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
| | - Chang Liu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
| | - Lu-Ping Zhou
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
| | - Kun Yang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
| | - Yun Cao
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
| | - Wei Li
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
| | - Cai-Liang Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
| | - Yin-Shun Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China.
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Accuracy and Safety of Robot-Assisted versus Fluoroscopy-Guided Posterior C1 Lateral Mass and C2 Pedicle Screw Internal Fixation for Atlantoaxial Dislocation: A Preliminary Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8508113. [PMID: 36132077 PMCID: PMC9484877 DOI: 10.1155/2022/8508113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/24/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
Objective To compare the accuracy, efficiency, and safety of robotic assistance (RA) and conventional fluoroscopy guidance for the placement of C1 lateral mass and C2 pedicle screws in posterior atlantoaxial fusion. Methods The data of patients who underwent posterior C1–C2 screw fixation (Goel-Harm's technique) in our hospital from August 2014 to March 2021 were retrospectively evaluated, including 14 cases under fluoroscopic guidance and 11 cases under RA. The hospital records, radiographic results, surgical data, and follow-up records were reviewed. Accuracy of screw placement was assessed using the Gertzbein and Robbins scale, and clinical outcomes were evaluated by Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS), modified MacNab criteria, and postoperative complications. Results Baseline characteristics of both groups were similar. The mean estimated blood loss in the fluoroscopic guidance and RA groups was 205.7 ± 80.3 mL and 120.9 ± 31.9 mL, respectively (p = 0.03). The mean surgical duration was 34 min longer with RA compared to that performed with free-hand (FH) method (p = 0.15). In addition, lower intraoperative radiation exposure was detected in the RA group (12.4 ± 1.4 mGy/screw) versus the FH (19.9 ± 2.1 mGy/screw) group (p = 0.01). The proportion of “clinically acceptable” screws (graded 0 and I) was higher in the RA group (93.2%) than that in the FH group (87.5%, p = 0.04). There was no significant difference in the increase of JOA score and decrease of VAS score between the two surgical procedures. Furthermore, there were no significant differences in overall clinical outcome between the two groups and no neurovascular complications associated with screw insertion. Conclusions RA is a safe and potentially more accurate alternative to the conventional fluoroscopic-guided FH technique for posterior atlantoaxial internal fixation.
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Tu P, Qin C, Guo Y, Li D, Lungu AJ, Wang H, Chen X. Ultrasound image guided and mixed reality-based surgical system with real-time soft tissue deformation computing for robotic cervical pedicle screw placement. IEEE Trans Biomed Eng 2022; 69:2593-2603. [PMID: 35157575 DOI: 10.1109/tbme.2022.3150952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cervical pedicle screw (CPS) placement surgery remains technically demanding due to the complicated anatomy with neurovascular structures. State-of-the-art surgical navigation or robotic systems still suffer from the problem of hand-eye coordination and soft tissue deformation. In this study, we aim at tracking the intraoperative soft tissue deformation and constructing a virtual physical fusion surgical scene, and integrating them into the robotic system for CPS placement surgery. Firstly, we propose a real-time deformation computation method based on the prior shape model and intraoperative partial information acquired from ultrasound images. According to the generated posterior shape, the structure representation of deformed target tissue gets updated continuously. Secondly, a hand tremble compensation method is proposed to improve the accuracy and robustness of the virtual-physical calibration procedure, and a mixed reality based surgical scene is further constructed for CPS placement surgery. Thirdly, we integrate the soft tissue deformation method and virtual-physical fusion method into our previously proposed surgical robotic system, and the surgical workflow for CPS placement surgery is introduced. We conducted phantom and animal experiments to evaluate the feasibility and accuracy of the proposed system. Our system yielded a mean surface distance error of 1.52 ± 0.43 mm for soft tissue deformation computing, and an average distance deviation of 1.04 ± 0.27 mm for CPS placement. Results demonstrated that our system involves tremendous clinical application potential. Our proposed system promotes the efficiency and safety of the CPS placement surgery.
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Bai H, Wang R, Wang Q, Xia GM, Xue Y, Dai Y, Zhang JX. Motor Bur Milling State Identification via Fast Fourier Transform Analyzing Sound Signal in Cervical Spine Posterior Decompression Surgery. Orthop Surg 2021; 13:2382-2395. [PMID: 34792301 PMCID: PMC8654648 DOI: 10.1111/os.13168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/24/2021] [Accepted: 10/19/2021] [Indexed: 01/18/2023] Open
Abstract
Objectives To investigate the real‐time sensitive feedback parameter of the motor bur milling state in cervical spine posterior decompression surgery, to possibly improve the safety of cervical spine posterior decompression and robot‐assisted spinal surgeries. Methods In this study, the cervical spine of three healthy male and three healthy female pigs were randomly selected. Six porcine cervical spine specimens were fixed to the vibration isolation system. The milling state of the motor bur was defined as the lamina cancellous bone (CA), lamina ventral corticalbone (VCO), and penetrating ventral cortical bone (PVCO). A 5‐mm bur milled the CA and VCO, and a 2‐mm bur milled the VCO and PVCO. A miniature microphone was used to collect the sound signal (SS) of milling lamina which was then extracted using Fast Fourier Transform (FFT). When using 5‐mm and 2‐mm bur to mill, the CA, VCO, and PVCO of each specimen were continuously collected at 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10 kHz frequencies for SS magnitudes. The study randomly selected the SS magnitudes of the CA and VCO continuously for 2 s at 1, 2, 3, 4, and 5 kHz frequencies for statistical analyses. When milling the VCO to the PVCO, we randomly collected the SS magnitudes of the VCO for consecutive 2 s and the SS magnitudes of continuous 2 s in the penetrating state at 1, 2, 3, 4, and 5 kHz frequencies for statistical analyses. The independent sample t‐test was used to compare the SS magnitudes of different milling states extracted from the FFT to determine the motor bur milling state. Results The SS magnitudes of the CA and VCO of all specimens extracted from the FFT at 1, 2, and 3 kHz were statistically different (P < 0.01); three specimens were not statistically different at a specific FFT‐extracted frequency (first specimen at 5 kHz, SS magnitudes of the CA were [25.94 ± 8.74] × 10−3, SS magnitudes of the VCO were [28.67 ± 12.94] × 10−3, P = 0.440; second specimen at 4 kHz, SS magnitudes of the CA were [23.79 ± 7.94] × 10−3, SS magnitudes of the VCO were [24.78 ± 4.32] × 10−3, P = 0.629; and third specimen at 5 kHz, SS magnitudes of the CA were [16.76 ± 6.20] × 10−3, SS magnitudes of the VCO were [17.69 ± 6.44] × 10−3, P = 0.643).The SS magnitudes of the VCO and PVCO of all the specimens extracted from the FFT at each frequency were statistically different (P < 0.001). Conclusions Based on the FFT extraction, the SS magnitudes of the motor bur milling state between the CA and VCO, the VCO and PVCO were significantly different, confirming that the SS is a potential sensitive feedback parameter for identifying the motor bur milling state. This study could improve the safety of cervical spine posterior decompression surgery, especially of robot‐assisted surgeries.
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Affiliation(s)
- He Bai
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Wang
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiu Wang
- Department of Rehabilitation, Tianjin Medical University General Hospital, Tianjin, China
| | - Guang-Ming Xia
- Tianjin Key Laboratory of Intelligent Robotics, College of Computer and Control Engineering, Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
| | - Yuan Xue
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Dai
- Tianjin Key Laboratory of Intelligent Robotics, College of Computer and Control Engineering, Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
| | - Jian-Xun Zhang
- Tianjin Key Laboratory of Intelligent Robotics, College of Computer and Control Engineering, Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
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Han XG, Tang GQ, Han X, Xing YG, Zhang Q, He D, Tian W. Comparison of Outcomes between Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion and Oblique Lumbar Interbody Fusion in Single-Level Lumbar Spondylolisthesis. Orthop Surg 2021; 13:2093-2101. [PMID: 34596342 PMCID: PMC8528977 DOI: 10.1111/os.13151] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the safety and effectiveness of robot‐assisted minimally invasive transforaminal lumbar interbody fusion (Mis‐TLIF) and oblique lumbar interbody fusion (OLIF) for the treatment of single‐level lumbar degenerative spondylolisthesis (LDS). Methods This is a retrospective study. Between April 2018 and April 2020, a total of 61 patients with single‐level lumbar degenerative spondylolisthesis and treated with robot‐assisted OLIF (28 cases, 16 females, 12 males, mean age 50.4 years) or robot‐assisted Mis‐TLIF (33 cases, 18 females, 15 males, mean age 53.6 years) were enrolled and evaluated. All the pedicle screws were implanted percutaneously assisted by the TiRobot system. Surgical data included the operation time, blood loss, and length of postoperative hospital stay. The clinical and functional outcomes included Oswestry Disability Index (ODI), Visual Analog scores (VAS) for back and leg pain, complication, and patient's satisfaction. Radiographic outcomes include pedicle screw accuracy, fusion status, and disc height. These data were collected before surgery, at 1 week, 3 months, 6 months, and 12 months postoperatively. Results There were no significantly different results in preoperative measurement between the two groups. There was significantly less blood loss (142.4 ± 89.4 vs 291.5 ± 72.3 mL, P < 0.01), shorter hospital stays (3.2 ± 1.8 vs 4.2 ± 2.5 days, P < 0.01), and longer operative time (164.9 ± 56.0 vs 121.5 ± 48.2 min, P < 0.01) in OLIF group compared with Mis‐TLIF group. The postoperative VAS scores and ODI scores in both groups were significantly improved compared with preoperative data (P < 0.05). VAS scores for back pain were significantly lower in OLIF group than Mis‐TLIF group at 1 week (2.8 ± 1.2 vs 3.5 ± 1.6, P < 0.05) and 3 months postoperatively (1.6 ± 1.0 vs 2.1 ± 1.1, P < 0.05), but there was no significant difference at further follow‐ups. ODI score was also significantly lower in OLIF group than Mis‐TLIF group at 3 months postoperatively (22.3 ± 10.0 vs 26.1 ± 12.8, P < 0.05). There was no significant difference in the proportion of clinically acceptable screws between the two groups (97.3% vs 96.2%, P = 0.90). At 1 year, the OLIF group had a higher interbody fusion rate compared with Mis‐TLIF group (96.0% vs 87%, P < 0.01). Disc height was significantly higher in the OLIF group than Mis‐TLIF group (12.4 ± 3.2 vs 11.2 ± 1.3 mm, P < 0.01). Satisfaction rates at 1 year exceeded 90% in both groups and there was no significant difference (92.6% for OLIF vs 91.2% for Mis‐TLIF, P = 0.263). Conclusion Robot‐assisted OLIF and Mis‐TLIF both have similar good clinical outcomes, but OLIF has the additional benefits of less blood loss, less postoperative hospital stays, higher disc height, and higher fusion rates. Robots are an effective tool for minimally invasive spine surgery.
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Affiliation(s)
- Xiao-Guang Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Guo-Qing Tang
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Xiao Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yong-Gang Xing
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Qi Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
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Patkar SV, Patkar P. Basilar Invagination: Surgical Treatment by Novel Anterior Implant. J Orthop Case Rep 2021; 11:36-39. [PMID: 35437498 PMCID: PMC9009472 DOI: 10.13107/jocr.2021.v11.i06.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Anterior retropharyngeal realignment, distraction, and atlantoaxial fixation are an option for the treatment of symptomatic basilar invagination (BI). The anterior implants for distraction and fixation for atlantoaxial joints are still evolving. We share our experience using a novel implant which can easily, safely, and rigidly fix both lateral masses to the body of the axis. Methods After exposing both the atlantoaxial joints anteriorly, the joints were prepared, distracted with wedge shaped autologous tricorticate bone grafts and realigned to correct the cervicomedullary strain. The atlantoaxial joints were fixed using a novel titanium plate by passing screws upwards and laterally into the lateral masses of the atlas and centrally into the body of the axis. Post-operative imaging showed effective correction of BI and atlantoaxial dislocation. Post-operative dynamic X-ray images confirmed maintenance of rigid fixation at 6 months. Conclusion This new plate screw construct is safe, easy, cost-efficient, and biomechanically appealing option for the treatment of symptomatic BI.
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Affiliation(s)
- Sushil V Patkar
- Department of Neurosurgery, Poona Hospital and Research Center, Pune, Maharashtra, India
| | - Pradnya Patkar
- Department of Neurosurgery, Royal Preston Hospital, Fulwood, Preston, United Kingdom
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Feng S, Lin J, Su N, Meng H, Yang Y, Fei Q. 3-Dimensional printing templates guiding versus free hand technique for cervical lateral mass screw fixation: A prospective study. J Clin Neurosci 2020; 78:252-258. [PMID: 32340846 DOI: 10.1016/j.jocn.2020.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/05/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In this randomized, single blind and controlled study, the feasibility and precision of 3-dimensional printing templates for cervical lateral mass screw insertion was evaluated. METHODS A total of 6 patients (72 screws), who were diagnosed with cervical spondylotic myelopathy (CSM) and developmental cervical spinal stenosis, were randomly divided into A and B two groups. All subjects underwent modified posterior surgery with using cervical lateral mass screws insertion (C4-C6). Group A underwent surgeries with screw insertion assisted by the guidance of 3-dimensional printing templates and Group B underwent surgeries with screw insertion by freehand. The criteria of the accuracy of screw placement were set as the main evaluation indicators. RESULTS There was no significant difference between the 2 groups in age, improvement rate of JOA, operation time and blood loss. According to Bayard's criteria, 32 screws (88.9%) were described as "acceptable" in group A and 22 screws (61.1%) were described as "acceptable" in Group B (P < 0.05). Based on our criteria, the "excellent and good" rate of screws was 83.3% in group A and 47.2% in Group B, respectively (P < 0.05). The precision of screws' location in Group A was superior to that in Group B. CONCLUSIONS 3-Dimensional printing screw insertion templates may achieve (1) comprehensive visualization of the cervical vertebrae and lateral mass and the individual surgical planning using the 3-dimensional model preoperatively. (2) increasing the accuracy of cervical lateral mass screw insertion.
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Affiliation(s)
- Shitong Feng
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, 100050, China
| | - Jisheng Lin
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, 100050, China
| | - Nan Su
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, 100050, China
| | - Hai Meng
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, 100050, China
| | - Yong Yang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, 100050, China.
| | - Qi Fei
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, 100050, China.
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Vadalà G, De Salvatore S, Ambrosio L, Russo F, Papalia R, Denaro V. Robotic Spine Surgery and Augmented Reality Systems: A State of the Art. Neurospine 2020; 17:88-100. [PMID: 32252158 PMCID: PMC7136092 DOI: 10.14245/ns.2040060.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 12/26/2022] Open
Abstract
Instrumented spine procedures have been performed for decades to treat a wide variety of spinal disorders. New technologies have been employed to obtain a high degree of precision, to minimize risks of damage to neurovascular structures and to diminish harmful exposure of patients and the operative team to ionizing radiations. Robotic spine surgery comprehends 3 major categories: telesurgical robotic systems, robotic-assisted navigation (RAN) and virtual augmented reality (AR) systems, including AR and virtual reality. Telesurgical systems encompass devices that can be operated from a remote command station, allowing to perform surgery via instruments being manipulated by the robot. On the other hand, RAN technologies are characterized by the robotic guidance of surgeon-operated instruments based on real-time imaging. Virtual AR systems are able to show images directly on special visors and screens allowing the surgeon to visualize information about the patient and the procedure (i.e., anatomical landmarks, screw direction and inclination, distance from neurological and vascular structures etc.). The aim of this review is to focus on the current state of the art of robotics and AR in spine surgery and perspectives of these emerging technologies that hold promises for future applications.
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Affiliation(s)
- Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Tian W, Fan M, Zeng C, Liu Y, He D, Zhang Q. Telerobotic Spinal Surgery Based on 5G Network: The First 12 Cases. Neurospine 2020; 17:114-120. [PMID: 32252160 PMCID: PMC7136105 DOI: 10.14245/ns.1938454.227] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/10/2020] [Indexed: 12/11/2022] Open
Abstract
Objective The purpose of this study was to determine the efficacy and feasibility of 5th generation wireless systems (5G) telerobotic spinal surgery in our first 12 cases.
Methods A total of 12 patients (5 males, 7 females; age, 23–71 years) with spinal disorders (4 thoracolumbar fractures, 6 lumbar spondylolisthesis, 2 lumbar stenosis) were treated with 5G telerobotic spinal surgery. Sixty-two pedicle screws were implanted. Results All patients had substantial relief from their symptoms. Screw placements were classified using Gertzbein-Robbins criteria. There were 59 grade A, 3 grade B. Mean operation time was 142.5 ± 46.7 minutes. Mean guiding wire insertion time was 41.3 ± 9.8 minutes. The deviation between the planned and actual positions was 0.76 ± 0.49 mm. No intraoperative adverse event was found.
Conclusion 5G remote robot-assisted spinal surgery is accurate and reliable. We conclude that 5G telerobotic spinal surgery is both efficacious and feasible for the management of spinal diseases with safety.
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Affiliation(s)
- Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Cheng Zeng
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Yajun Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Da He
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Qi Zhang
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
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12
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Zhang Q, Han XG, Xu YF, Fan MX, Zhao JW, Liu YJ, He D, Tian W. Robotic navigation during spine surgery. Expert Rev Med Devices 2019; 17:27-32. [PMID: 31778610 DOI: 10.1080/17434440.2020.1699405] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction: Potential complications associated with screw malposition may result in neurological deficits or vascular injuries. Spine surgery has significantly developed under the assistance of technological progress. The advantages of applying robotic technology in spine surgery include the possibility of improving screw accuracy, reducing complications, decreasing fluoroscopy use.Areas covered: We critically evaluated the current literature on the radiographic and clinical outcomes of robotic-assisted spine surgery, including accuracy, radiation exposure, operative time, and complication rates.Expert opinion: Robotic-assisted spine surgery shows promising results and has the potentials for further investigations. The robot-assisted spine surgery is appeared to be more accurate in pedicle screw placement than the free-hand technique. In general, the robot-assisted technique is associated with shorter radiation exposure time but longer operative time than free-hand technique. For higher accuracy of robotic-assisted spine surgery, technical advancement and high-quality researches are needed. Artificial intelligent technology, decompression function, and higher accuracy are the directions for the development of robotic-assisted spine surgery.
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Affiliation(s)
- Qi Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Xiao-Guang Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yun-Feng Xu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Ming-Xing Fan
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Jing-Wei Zhao
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Ya-Jun Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
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