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04 April 2019 : Clinical Research  

Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement for Treatment of Lumbar Spondylolisthesis: A Comparative Cohort Study

Jun-Song Yang1EF, Baorong He1C, Fang Tian1B, Tuan-Jiang Liu1B, Peng Liu1F, Jia-Nan Zhang1C, Shi-Chang Liu1D, Yuan Tuo1F, Lei Chu2F, Ding-Jun Hao1AG*

DOI: 10.12659/MSM.913124

Med Sci Monit 2019; 25:2479-2487

Abstract

BACKGROUND: With the in-depth development of minimally invasive spine surgery in recent years, robot- and computer-assisted technologies have been increasingly used and successfully applied to spinal surgery.

MATERIAL AND METHODS: We performed a retrospective analysis of 60 patients with grade I or II lumbar spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) from January 2017 to December 2017. A robot-assisted surgical system was used in 30 patients for pedicle screw placement. The other 30 patients underwent fluoroscopy-guided percutaneous pedicle screw placement.

RESULTS: There were 130 screws placed under fluoroscopic guidance, with 26.2% penetration of the pedicle wall. There were 130 screws placed in robotic-assisted surgery, with 6.2% penetration of the pedicle wall. Severe screw deviation (Neo grade III) was identified in 4 screws in the fluoroscopy-guided group, while no severe deviation was noted in the robot-assisted group. In the fluoroscopic group, 15.6% of screws penetrated the superior articular process, and 2.1% screws had severe complications (Babu grade III). However, only 5.1% of screws in the robot-assisted group had severe complications. The mean screw insertion angle was significantly greater in the robot-assisted group than in the fluoroscopy-guided group (23.8±6.1° vs. 18.4±7.2°, P=0.017).

CONCLUSIONS: Compared to fluoroscopy-guided percutaneous pedicle screw placement, robot-assisted percutaneous pedicle screw placement has the following advantages: greater accuracy, lower incidences of screw penetration of the pedicle wall and invasion of the facet joints, and better screw insertion angle. Combined with MIS-TLIF, robot-assisted percutaneous pedicle screw placement is an effective minimally invasive treatment for lumbar spondylolisthesis.

Keywords: Orthopedic Fixation Devices, Robotics, Spine, spondylolisthesis, Cohort Studies, Lumbar Vertebrae, Lumbosacral Region, Minimally Invasive Surgical Procedures, Pedicle Screws, Robotic Surgical Procedures, Spinal Fusion, Surgery, Computer-Assisted

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750