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Benzakour A, Altsitzioglou P, Lemée JM, Ahmad A, Mavrogenis AF, Benzakour T. Artificial intelligence in spine surgery. INTERNATIONAL ORTHOPAEDICS 2023; 47:457-465. [PMID: 35902390 DOI: 10.1007/s00264-022-05517-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 01/28/2023]
Abstract
The continuous progress of research and clinical trials has offered a wide variety of information concerning the spine and the treatment of the different spinal pathologies that may occur. Planning the best therapy for each patient could be a very difficult and challenging task as it often requires thorough processing of the patient's history and individual characteristics by the clinician. Clinicians and researchers also face problems when it comes to data availability due to patients' personal information protection policies. Artificial intelligence refers to the reproduction of human intelligence via special programs and computers that are trained in a way that simulates human cognitive functions. Artificial intelligence implementations to daily clinical practice such as surgical robots that facilitate spine surgery and reduce radiation dosage to medical staff, special algorithms that can predict the possible outcomes of conservative versus surgical treatment in patients with low back pain and disk herniations, and systems that create artificial populations with great resemblance and similar characteristics to real patients are considered to be a novel breakthrough in modern medicine. To enhance the body of the related literature and inform the readers on the clinical applications of artificial intelligence, we performed this review to discuss the contribution of artificial intelligence in spine surgery and pathology.
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Affiliation(s)
- Ahmed Benzakour
- Centre Orléanais du Dos - Pôle Santé Oréliance, Saran, France
| | - Pavlos Altsitzioglou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Jean Michel Lemée
- Department of Neurosurgery, University Hospital of Angers, Angers, France
| | | | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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Kumar V, Patel S, Baburaj V, Vardhan A, Singh PK, Vaishya R. Current understanding on artificial intelligence and machine learning in orthopaedics - A scoping review. J Orthop 2022; 34:201-206. [PMID: 36104993 PMCID: PMC9465367 DOI: 10.1016/j.jor.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background Artificial Intelligence (AI) has improved the way of looking at technological challenges. Today, we can afford to see many of the problems as just an input-output system rather than solving from the first principles. The field of Orthopaedics is not spared from this rapidly expanding technology. The recent surge in the use of AI can be attributed mainly to advancements in deep learning methodologies and computing resources. This review was conducted to draw an outline on the role of AI in orthopaedics. Methods We developed a search strategy and looked for articles on PubMed, Scopus, and EMBASE. A total of 40 articles were selected for this study, from tools for medical aid like imaging solutions, implant management, and robotic surgery to understanding scientific questions. Results A total of 40 studies have been included in this review. The role of AI in the various subspecialties such as arthroplasty, trauma, orthopaedic oncology, foot and ankle etc. have been discussed in detail. Conclusion AI has touched most of the aspects of Orthopaedics. The increase in technological literacy, data management plans, and hardware systems, amalgamated with the access to hand-held devices like mobiles, and electronic pads, augur well for the exciting times ahead in this field. We have discussed various technological breakthroughs in AI that have been able to perform in Orthopaedics, and also the limitations and the problem with the black-box approach of modern AI algorithms. We advocate for better interpretable algorithms which can help both the patients and surgeons alike.
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Affiliation(s)
- Vishal Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sandeep Patel
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vishnu Baburaj
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aditya Vardhan
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Prasoon Kumar Singh
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Zhang X, Guo Y, Li Y. Comparison of the clinical efficacy of two fixation methods combined with OLIF in the treatment of lumbar spondylolisthesis in adult patients. J Orthop Surg Res 2022; 17:115. [PMID: 35189897 PMCID: PMC8862256 DOI: 10.1186/s13018-022-02991-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background To observe the clinical efficacy of an anterior single rob-screw fixation (ASRSF) combined with the oblique lumbar intervertebral fusion (OLIF) approach compared with a posterior percutaneous screw fixation (PPSF) combined with OLIF in the treatment of lumbar spondylolisthesis. Method This is a retrospective case–control study. Patients with degenerative lumbar spondylolisthesis (DLS) treated with either ASRSF combined with OLIF or PPSF combined with OLIF from January 2016 to January 2018 were enrolled in this study. None of the patients had posterior decompression. The visual analog scale (VAS) and Oswestry dysfunction index (ODI) were used for clinical efficacy assessment. The pre- and post-operational disc height, height of foramen, subsidence, and migration of cages, fusion rate and surgery-related complications were compared between the two groups. Results Fifty-three patients were included in this single-center study. According to the fixation methods, patients were divided into the ASRSF group (group A, 25 cases) and the PPSF group (group B, 28 cases). There was no statistical difference in surgery-related complications between groups. There was a significant difference in the VAS score at one-week post-surgery (2.3 ± 0.5 vs. 3.5 ± 0.4, P = 0.01), and three months post-operation (2.2 ± 0.3 vs. 3.0 ± 0.3, P = 0.01). Comparison of post-operative imaging data showed that there was a significant difference in the height of the foramen between groups at three months post-surgery(18.1 ± 2.3 mm vs. 16.9 ± 1.9 mm, P = 0.04). At 24 months post-surgery, the ODI was 12.65 ± 3.6 in group A and 19.1 ± 3.4 in group B (P = 0.01). Twelve months after surgery, the fusion rate in group A at 72.0% and 78.6% in group B was not statistically significant (P = 0.75). Fusion was identified in all patients at 24 months post-surgery. Conclusion When compared to PPSF, ASRSF combined with OLIF for DLS can reduce post-operative low back pain in the initial stages, maintain the height of the foramen and improve the performance of lumbar function.
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Affiliation(s)
- Xinliang Zhang
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated Honghui Hospital, Xi'an, 710000, Shaanxi, China
| | - Yunshan Guo
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated Honghui Hospital, Xi'an, 710000, Shaanxi, China
| | - Yibing Li
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated Honghui Hospital, Xi'an, 710000, Shaanxi, China.
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Cui GY, Han XG, Wei Y, Liu YJ, He D, Sun YQ, Liu B, Tian W. Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis. Orthop Surg 2021; 13:1960-1968. [PMID: 34516712 PMCID: PMC8528995 DOI: 10.1111/os.13044] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 03/25/2021] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
Objective To compare the clinical efficacy between robot‐assisted minimally invasive transforaminal lumbar interbody fusion (robot‐assisted MIS‐TLIF) and traditional open TLIF surgery in the treatment of lumbar spondylolisthesis. Methods According to the inclusion and exclusion criteria, 48 cases with lumbar spondylolisthesis who received surgical treatment from June 2016 to December 2017 in the spinal surgery department of Beijing Jishuitan Hospital were analyzed in this study, including 23 patients who received robot‐assisted MIS‐TLIF and 25 patients who received traditional open TLIF surgery. The two groups were compared in terms of pedicle screw accuracy evaluated by Gertzbein‐Robbins classification on postoperative computed tomography (CT), operation time, blood loss, postoperative drainage, hospitalization, time to independent ambulation, low back pain evaluated by visual analog scale (VAS), lumbar function evaluated by Oswestry Disability Index (ODI), paraspinal muscles atrophy on magnetic resonance imaging (MRI), and complications. Results Postoperative CT showed that the rate of Grade A screws in the robot‐assisted MIS‐TLIF group was significantly more than that in the open surgery group (χ2 = 4.698, P = 0.025). Compared with the open surgery group, the robot‐assisted MIS‐TLIF group had significantly less intraoperative blood loss, less postoperative drainage, shorter hospitalization, shorter time to independent ambulation, and lower VAS at 3 days post‐operation (P < 0.05). However, the duration of surgery was longer. The VAS of the robot‐assisted MIS‐TLIF group decreased from 6.9 ± 1.8 at pre‐operation to 2.1 ± 0.8 at post‐operation, 1.8 ± 0.7 at 6‐month follow‐up and 1.6 ± 0.5 at 2‐year follow‐up. The VAS of the open surgery group decreased from 6.5 ± 1.7 at pre‐operation to 3.7 ± 2.1 at post‐operation, 2.1 ± 0.6 at 6‐month follow‐up and 1.9 ± 0.5 at 2‐year follow‐up. The ODI of the robot‐assisted MIS‐TLIF group decreased from 57.8% ± 8.9% at pre‐operation to 18.6% ± 4.7% at post‐operation, 15.7% ± 3.9% at 6‐month follow‐up and 14.6% ± 3.7% at 2‐year follow‐up. The ODI of the open surgery group decreased from 56.9% ± 8.8% at pre‐operation to 20.8% ± 5.1% at post‐operation, 17.3% ± 4.2% at 6‐month follow‐up and 16.5% ± 3.8% at 2‐year follow‐up. Paraspinal muscle cross‐sectional area in 2‐year follow‐up in patients of the open surgery group decreased significantly compared to patients of robotic‐assisted MIS‐TLIF group (P = 0.016). Conclusion In the treatment of lumbar spondylolisthesis, robot‐assisted MIS‐TLIF may lead to more precise pedicle screw placement, less intraoperative blood loss, less postoperative drainage, less postoperative pain, quicker recovery, and less paraspinal muscle atrophy than traditional open surgery.
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Affiliation(s)
- Guan-Yu Cui
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Xiao-Guang Han
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Yi Wei
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Ya-Jun Liu
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Da He
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Yu-Qing Sun
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Bo Liu
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Wei Tian
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
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Shi B, Jiang T, Du H, Zhang W, Hu L, Zhang L. Application of Spinal Robotic Navigation Technology to Minimally Invasive Percutaneous Treatment of Spinal Fractures: A Clinical, Non-Randomized, Controlled Study. Orthop Surg 2021; 13:1236-1243. [PMID: 33942548 PMCID: PMC8274181 DOI: 10.1111/os.12993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To introduce a new robotic navigation system that assists pedicle screw implantation and verify the accuracy and stability of the system. Methods Pedicle screw placements were performed on the thoracic vertebrae (T)9–Lumbar vertebrae (L)5 thoracolumbar vertebrae of cadavers using robotic guidance. The operative duration, puncture success, correction, and correction time were assessed. Additionally, a total of 30 thoracolumbar fractures from September 2017 until June 2019 were included in a clinical study. Two groups were evaluated: the robotic guidance group and freehand group. Both sexes were evaluated. Mean ages were 47.0 and 49.1 years, respectively, in the robotic and freehand groups. Inclusion criteria was age >18 years and a thoracolumbar fracture. Intervention was the operative treatment of thoracolumbar fractures. Outcome parameters were the operation time, intraoperative bleeding, and fluoroscopic data. The accuracy of the pedicle screw placement and screw penetration rate of the two groups were compared using intraoperative fluoroscopic axial images. Results The success rate for 108 one‐time nail placements in cadavers was 88% and two‐time nail placement was 100%. Vertebral punctures at L5 took the longest to perform and achieve correction. Clinically, there were no significant differences in patients' sex, body mass index, age distribution, or intraoperative bleeding between the groups. The average X‐ray exposure time for patients and operators were 37.69 ± 9.24 s and 0 s in the robotic group (significantly lower than in the freehand group: 81.24 ± 6.97 s vs 56.29 ± 7.93 s, respectively). Success rates for one‐time screw placements were 98.64 and 88.46% in the robotic and freehand groups, respectively, which is significant. Screw penetration rates (1.36% vs 11.54%, robotic vs freehand), were significantly different. Conclusions The robotic system improved the accuracy and safety of pedicle screw internal fixation and reduced patients' and operators' intraoperative radiation exposure.
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Affiliation(s)
- Bin Shi
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Tianyu Jiang
- Department of Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Hailong Du
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Lei Hu
- Robotics Institute, Beihang University, Beijing, China
| | - Lihai Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
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Guo Y, Ma W, Tong D, Liu K, Yin Y, Yang C. Robot-assisted double screw fixation of minimally displaced scaphoid waist fracture nonunions or delayed unions without bone graft. J Hand Surg Eur Vol 2021; 46:286-291. [PMID: 32757694 DOI: 10.1177/1753193420944546] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively reviewed 12 minimally displaced fractures of the scaphoid waist in 12 patients who developed delayed or nonunions with or without conservative treatment. Mean time between injury and surgery was 6 months (range 3-12). The fractures were stabilized with double screws, which were percutaneously inserted with robot assistance, and without bone grafting. All fractures united at a mean of 8 weeks (range 6-10) after surgery. The patients were followed-up at 6 months and 1 year. The patients recovered good wrist function. No major postoperative complications were reported, and the patients returned to their usual level of activity. Robot assistance gave a high degree of accuracy when placing the cannulated screws since only two attempts were needed for correct placement of the guide wires. We explain the high union incidence by patient selection, good stabilization and not disturbing the vascular supply.Level of evidence: IV.
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Affiliation(s)
- Yang Guo
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Ma
- Department of Orthopedics, Air Force Special Medical Center, Beijing, China
| | - Dedi Tong
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Kun Liu
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yaobin Yin
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Chen Yang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, China
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Learning Curve of Robot-Assisted Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures. World Neurosurg 2020; 138:e323-e329. [DOI: 10.1016/j.wneu.2020.02.110] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
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Artificial intelligence in orthopedic surgery: current state and future perspective. Chin Med J (Engl) 2020; 132:2521-2523. [PMID: 31658155 PMCID: PMC6846263 DOI: 10.1097/cm9.0000000000000479] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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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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Fan M, Liu Y, He D, Han X, Zhao J, Duan F, Liu B, Tian W. Improved Accuracy of Cervical Spinal Surgery With Robot-Assisted Screw Insertion: A Prospective, Randomized, Controlled Study. Spine (Phila Pa 1976) 2020; 45:285-291. [PMID: 31568094 DOI: 10.1097/brs.0000000000003258] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, randomized, controlled trial. OBJECTIVE To compare robot-assisted and conventional implantation techniques by evaluating the accuracy and safety of implanting screws in cervical vertebrae. SUMMARY OF BACKGROUND DATA Cervical spinal surgery is difficult and dangerous as screw misplacement might lead not only to decreased stability but also neurological, vascular, and visceral injuries. A new robot-assisted surgical procedure has been introduced to improve the accuracy of implant screw positioning. METHODS We randomly assigned 135 patients with newly diagnosed cervical spinal disease and who required screw fixation using either robot-assisted or conventional fluoroscopy-assisted cervical spinal surgery. The primary outcomes were the discrepancies between the planned trajectories and the actual screw positions. RESULTS Altogether, 127 patients underwent the assigned intervention (61 robot-assisted and 66 conventional fluoroscopy-assisted). The baseline characteristics including the screw types, were similar in the two groups. Altogether, 390 screws were planed and placed in the cervical vertebrae, and 94.9% were acceptable. The robot-assisted group had a better screw placement accuracy than the conventional fluoroscopy-assisted group with associated P values <0.001 (0.83 [0.44, 1.29] vs. 1.79 [1.41, 2.50] mm). The Gertzbein and Robbins scales also showed a significant difference between the two groups (P < 0.001). Furthermore, the robot-assisted group experienced significantly less blood loss during surgery than the conventional fluoroscopy-assisted group (200 [50, 375] vs. 350 [100, 500] mL; P = 0.002) and shorter length of stay after surgery (P = 0.021). These two groups did not differ significantly regarding the duration of the operation (P = 0.525). Neurological injury occurred in one case in the conventional fluoroscopy-assisted group. CONCLUSION The accuracy and clinical outcomes of cervical spinal surgery using the robot-assisted technique tended to be superior to those with the conventional fluoroscopy-assisted technique in this prospective, randomized, controlled trial. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yajun Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Da He
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Han
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Jingwei Zhao
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Fangfang Duan
- Epidemiological Research Department, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
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Tian Y, Zhang J, Chen H, Ding K, Liu T, Huang D, Hao D. [A comparative study of spinal robot-assisted and traditional fluoroscopy-assisted percutaneous reduction and internal fixation for single-level thoracolumbar fractures without neurological symptoms]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:69-75. [PMID: 31939238 DOI: 10.7507/1002-1892.201905057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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 ( χ 2=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 ( χ 2=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.
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Affiliation(s)
- Ye Tian
- Xi'an Medical University, Xi'an Shaanxi, 710068, P.R.China;Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Jianan Zhang
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Hao Chen
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Keyuan Ding
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Tuanjiang Liu
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Dageng Huang
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Dingjun Hao
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054,
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Abstract
INTRODUCTION Direct repair of the pars defect in lumbar spondylolysis is an effective surgical procedure, but it is technically challenging. We assessed the feasibility of a new robotic system for intralaminar screw fixation of spondylolysis. PATIENT CONCERNS A 26-year-old man complained about frequent low back pain after failed conservative treatments. DIAGNOSIS The lumbar computed tomography images demonstrated the presence of bilateral spondylolysis at the L5 level, with no spondylolisthesis. INTERVENTIONS We performed one surgery of direct intralaminar screw fixation under the guidance of the TiRobot system. The trajectory of the screw was planned based on intraoperative 3-dimensional radiographic images. Then, the robotic arm spontaneously moved to guide the guide wires and screw insertion. OUTCOMES Bilateral L5 intralaminar screws were safely and accurately placed. No intraoperative complications occurred. Postoperative computed tomography showed good radiological results, without cortical perforation. CONCLUSION We report the first case of robot-assisted direct intralaminar screw fixation for spondylolysis using the TiRobot system. Robotic guidance for direct repair of spondylolysis could be feasible.
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Affiliation(s)
- Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Qi Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Xiao-Guang Han
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Qiang Yuan
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ya-Jun Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
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13
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Feng S, Tian W, Wei Y. Clinical Effects of Oblique Lateral Interbody Fusion by Conventional Open versus Percutaneous Robot-Assisted Minimally Invasive Pedicle Screw Placement in Elderly Patients. Orthop Surg 2019; 12:86-93. [PMID: 31880084 PMCID: PMC7031580 DOI: 10.1111/os.12587] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 11/03/2019] [Accepted: 11/08/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To compare the clinical outcomes of percutaneous robot-assisted minimally invasive pedicle screw insertion versus freehand fluoroscopy-assisted pedicle screw insertion using a traditional open technique in elderly patients undergoing an oblique lumbar interbody fusion (OLIF) procedure. METHODS Based on the inclusion and exclusion criteria, 80 patients with lumbar degenerative disease who attended the spinal surgery department of the Beijing Jishuitan Hospital between January 2017 and April 2018 were enrolled in the present study. Patients were randomized 1:1 to undergo percutaneous robot-assisted minimally invasive pedicle screw insertion (experimental group, n = 40) or freehand fluoroscopy-assisted pedicle screw insertion using a traditional open technique (control group, n = 40). Outcomes were accuracy of screw placement evaluated on postoperative CT using the modified Gertzbein and Robbins scale, operative time, blood loss, postoperative drainage, lower back and leg pain evaluated using a visual analogue scale (VAS), lumbar function evaluated using the Oswestry disability index (ODI), and complication rates. RESULTS A total of 344 vertebral pedicle screws were inserted: 170 screws in the experimental group, and 174 screws in the control group. Accurate screw placement was significantly higher in the experimental group (98.2% [167/170]) than in the control group (93.1% [162/174]). Clinical outcomes showed significant differences between the experimental and control groups in operative time, intraoperative blood loss, and postoperative VAS for lower back pain in the immediate postoperative period. CONCLUSION Robot-assisted pedicle screw insertion in OLIF is an effective strategy for the management of elderly patients with lumbar degenerative diseases.
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Affiliation(s)
- Shuo Feng
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yi Wei
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
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14
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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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15
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Liu B, Wu F, Chen S, Jiang X, Tian W. Robot-assisted percutaneous scaphoid fracture fixation: a report of ten patients. J Hand Surg Eur Vol 2019; 44:685-691. [PMID: 31096829 DOI: 10.1177/1753193419848595] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study reports the technique, efficacy and safety of robotic-assisted, computer-navigated, percutaneous fixation of scaphoid fractures. Ten males with acute undisplaced waist fractures underwent fixation with this method using a commercially available three-dimensional fluoroscopy unit and robotic navigation system. The mean total operative duration was 40 minutes, which comprised of a set-up time of 18 minutes and planning and surgical time of 22 minutes. All patients required only a single guidewire insertion attempt, and there were no screw protuberances or other complications. All fractures united at a mean of 8 weeks. At a mean follow-up of 6.5 months (range 6-8), the mean Mayo wrist score was 96, patient-rated wrist evaluation was 2, flexion-extension arc was 96% and grip strength was 91% of the contralateral side. We conclude from our patients that robotic-assisted percutaneous scaphoid fixation is feasible, safe and accurate, and is a satisfactory method for treating these injuries. Level of evidence: IV.
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Affiliation(s)
- Bo Liu
- 1 Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Feiran Wu
- 2 Department of Orthopaedics, University Hospitals Birmingham, Birmingham, UK
| | - Shanlin Chen
- 1 Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Xieyuan Jiang
- 3 Department of Orthopaedics and Traumatology, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Wei Tian
- 4 Department of Spine Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
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16
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Wu JY, Yuan Q, Liu YJ, Sun YQ, Zhang Y, Tian W. Robot-assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique. Orthop Surg 2019; 11:25-33. [PMID: 30776856 PMCID: PMC6430475 DOI: 10.1111/os.12428] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 12/28/2018] [Indexed: 01/02/2023] Open
Abstract
Objectives Percutaneous transfacet screw fixation (pTSF) is a minimally invasive posterior fixation technique supplementing oblique lateral interbody fusion (OLIF) for lumbar spinal disorders. Accurate screw insertion is difficult to achieve and technically demanding under 2‐D fluoroscopy. Recently developed robot‐assisted spinal surgery demonstrated a high level of accuracy of pedicle screw insertion and a low complication rate. No published study has reported this combination technique. The aim of our study was to evaluate the accuracy and safety properties of the combination of both minimally invasive techniques: robot‐assisted pTSF supplementing the OLIF procedure. Methods This was an experimental and prospective study. Selected consecutive patients with lumbar degenerative disorders received robot‐assisted pTSF supplementing the OLIF procedure using the TianJi Robot system operated by one senior surgeon from March to October 2018. The accuracy of screw insertion and perioperative screw‐related complications were evaluated. Assessment of the accuracy of screw insertion included intraoperative robotic guidance accuracy and incidence of screw encroachments. Intraoperative robotic guidance accuracy referred to translational and angular deviations of screws, which were assessed by comparing the planned and actual screw trajectories guided by the robot on reconstructed images using TianJi Robot Planning Software. Screw encroachments were evaluated on postoperative CT images and classified by a grading system (A, excellent; B, good; C, poor). Screw‐related complications including intraoperative pin skidding, screw malposition and adjustment, together with postoperative neurological symptoms that correlated with screw malposition were recorded. Results Ten patients, with an average age of 60.2 years, were selected and recruited in this study. All cases were degenerative lumbar spinal disorders, out of which there were 6 cases of Meyerding Grade I degenerative spondylolisthesis. Twenty‐four transfacet screws were inserted by robotic assistance. Instrumented levels included nine segments at L4–5 level and three segments at L3–4 level. Two patients had both L4–5 and L3–4 level fixation. The average surgical time was 3.3 h (SD, 0.8 h). The mean blood loss was 90 mL (SD, 32 mL). Intraoperative guidance accuracy showed 1.09 ± 0.17 mm (ranging from 0.75 to 1.22 mm) translational deviation and 2.17° ± 0.39° (ranging from 1.47° to 2.54°) angular deviation. The gradings of screw encroachment were: 17 screws (71%) with Grade A, 6 screws (25%) with Grade B, and 1 screw (4%) with Grade C. Only one pin skidding occurred intraoperatively and revised subsequently. No postoperative neurological complications were found. Conclusion Our preliminary study of robot‐assisted pTSF supplementing the OLIF procedure showed a high level of accuracy for screw insertion and this minimally invasive combination technique was found to be a feasible and safe procedure.
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Affiliation(s)
- Jing-Ye Wu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Qiang Yuan
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Ya-Jun Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yu-Qing Sun
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yong Zhang
- TINAVI Medical Technologies Co., Ltd, 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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17
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Feng S, Tian W, Sun Y, Liu Y, Wei Y. Effect of Robot-Assisted Surgery on Lumbar Pedicle Screw Internal Fixation in Patients with Osteoporosis. World Neurosurg 2019; 125:e1057-e1062. [PMID: 30790729 DOI: 10.1016/j.wneu.2019.01.243] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We sought to compare clinical outcomes of robot-assisted versus conventional freehand fluoroscopy-assisted lumbar pedicle screw insertion in patients with osteoporosis. METHODS This study included 80 patients with osteoporosis and lumbar disease treated with pedicle screw internal fixation in the Department of Spine Surgery, Beijing Jishuitan Hospital between June 2016 and July 2018. Patients were randomly assigned to receive either robot-assisted pedicle screw insertion (experimental group) or freehand fluoroscopy-assisted pedicle screw insertion (control group). The accuracy of screw placement was assessed with postoperative computed tomography. Operative time, pedicle screw placement time, radiation exposure to the medical team, and intraoperative blood loss were recorded. RESULTS A total of 427 pedicle screws were inserted in 80 patients; 202 pedicle screws were placed in the experimental group, and 225 pedicle screws were placed in the control group. The accuracy of screw placement was significantly higher with robot-assisted pedicle screw insertion (98.5% [199/202]) compared with that achieved with the freehand technique (91.6% [206/225]) (P < 0.05). Robot-assisted pedicle screw insertion was associated with reductions in the mean total pedicle screw placement time (27.60 ± 8.58 vs. 32.26 ± 10.48 minutes), radiation exposure to the medical team (2.23 ± 0.62 vs. 3.35 ± 0.80 fluoroscopic images), and intraoperative blood loss (254.75 ± 115.34 vs. 356.25 ± 141.00 mL; P < 0.05). The mean operative time did not differ significantly between the groups. CONCLUSIONS Robot-assisted pedicle screw insertion is a more effective surgical option for patients with osteoporosis who present with various spine diseases compared with fluoroscopy-assisted freehand screw placement techniques.
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Affiliation(s)
- Shuo Feng
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.
| | - Yuqing Sun
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yajun Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yi Wei
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
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18
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Zhang Q, Han XG, Xu YF, Liu YJ, Liu B, He D, Sun YQ, Tian W. Robot-Assisted Versus Fluoroscopy-Guided Pedicle Screw Placement in Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Disease. World Neurosurg 2019; 125:e429-e434. [PMID: 30708077 DOI: 10.1016/j.wneu.2019.01.097] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To compare the clinical accuracy and perioperative outcomes for pedicle screw placement in transforaminal lumbar interbody fusion (TLIF) between the robot-assisted (RA) technique and fluoroscopy-guided (FG) technique. METHODS Seventy-seven patients scheduled to undergo RA (n = 43) and FG (n = 44) TLIF surgery were included. Patient demographics, radiographic accuracy, and perioperative outcomes were recorded and compared. The accuracy of pedicle screw placement was according to the Gertzbein and Robbins scale and facet joint violation. Perioperative outcomes mainly included operative time, radiation exposure, and revisions. RESULTS Of the 176 screws in the RA group, 164 screws were grade A, and 9, 2, and 1 screws were grades B, C, and D, respectively. Of the 204 screws in the FG group, 175 screws were grade A, with 16 screws scored as grade B, 8 screws scored as grade C, 3 screws scored as grade D, and 2 screws scored as grade E. The rate of perfect screw position (grade A) was higher in the RA group than in the FG group (93.2% vs. 85.8%, respectively; P = 0.020). In the FG group, 191 screws (93.6%) were clinically acceptable (groups A and B), whereas more acceptable screw positions were achieved in the RA group (98.3%; P = 0.024). Fewer screws in the RA group violated the proximal facet joint (5 vs. 24 screws, respectively; P = 0.001). The radiation dose was lower in the RA group (25.9 ± 14.2 vs. 70.5 ± 27.3 μSv, respectively; P < 0.001). Two screws in the FG group required a revision, but no revision was required in the RA group. CONCLUSIONS RA pedicle screw placement is an accurate and safe procedure in TLIF for lumbar degenerative disease.
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Affiliation(s)
- Qi Zhang
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine and Beijing Jishuitan Hospital, Beijing, China
| | - Xiao-Guang Han
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine and Beijing Jishuitan Hospital, Beijing, China
| | - Yun-Feng Xu
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine and Beijing Jishuitan Hospital, Beijing, China
| | - Ya-Jun Liu
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine and Beijing Jishuitan Hospital, Beijing, China
| | - Bo Liu
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine and Beijing Jishuitan Hospital, Beijing, China
| | - Da He
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine and Beijing Jishuitan Hospital, Beijing, China
| | - Yu-Qing Sun
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine and Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine and Beijing Jishuitan Hospital, Beijing, China.
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19
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Zhang YZ. Brave to Advance the Theoretical and Technological Innovation on the Basis of Orthopedic Practice. Chin Med J (Engl) 2018; 131:2521-2523. [PMID: 30381584 PMCID: PMC6213838 DOI: 10.4103/0366-6999.244123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Ying-Ze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051; Chinese Academy of Engineering, Beijing 100088, China
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