Short-term effectiveness comparison between robotic-guided percutaneous minimally invasive pedicle screw internal fixation and traditional open internal fixation in treatment of thoracolumbar fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

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

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

Corresponding?author：

HU Jiang, Email: hujiang8711@163.com

Keywords：

Robot; thoracolumbar fracture; minimally invasive; internal fixation

DOI：

10.7507/1002-1892.201906105

Video：

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Objective To compare short-term effectiveness between robot-guided percutaneous minimally invasive pedicle screw internal fixation and traditional open internal fixation in the treatment of thoracolumbar fractures.Methods The clinical data of 52 cases of thoracolumbar fracture without neurological injury symptoms admitted between January 2018 and May 2018 were retrospectively analyzed. According to the different surgical methods, they were divided into minimally invasive group (24 cases, treated with robot-assisted percutaneous minimally invasive pedicle screw internal fixation) and open group (28 cases, treated with traditional open internal fixation). There was no significant difference between the two groups in the general data such as gender, age, cause of injury, fracture segment, thoracolumbar injury classification and severity score (TLICS), preoperative back pain visual analogue scale (VAS) score, Oswestry disability index (ODI) score, fixed segment height, and fixed segment kyphosis Cobb angle (P>0.05). The operation time, intraoperative blood loss, and hospitalization time of the two groups were recorded and compared; as well as the VAS score, ODI score, fixed segment height, and fixed segment kyphosis Cobb angle of the two groups before operation and at 3 days, 1 month, 6 months, and 10 months after operation. CT scan was reexamined at 1-3 days after operation, and the pedicle screw insertion accuracy rate was determined and calculated according to Gertzbein-Robbins classification standard.Results The operation time of the minimally invasive group was significantly longer than that of the open group, but the intraoperative blood loss and hospitalization time were significantly shorter than those of the open group (P<0.05). There were 132 pedicle screws and 158 pedicle screws implanted in the minimally invasive group and the open group respectively. According to the Gertzbein-Robbins classification standard, the accuracy of pedicle screws was 97.7% (129/132) and 96.8% (153/158), respectively, showing no significant difference between the two groups (χ²=0.505, P=0.777). The patients in both groups were followed up 10 months, and there was no rejection or internal fixation fracture. In the minimally invasive group, the internal fixator was removed at 10 months after operation, but not in the open group. The VAS score, ODI score, fixed segment heigh, and fixed segment kyphotic Cobb angle of the two groups were improved in different degrees when compared with preoperative ones (P<0.05). Except that the VAS score and ODI score of the minimally invasive group were significantly better than those of the open group at 3 days after operation (P<0.05), there was no significant difference between the two groups at other time points (P>0.05).Conclusion Robot-assisted percutaneous minimally invasive pedicle screw internal fixation for thoracolumbar fractures has significant advantages in intraoperative blood loss, hospitalization time, and early postoperative effectiveness and other aspects, and the effect of fracture reduction is good.

Citation： LIN Shu, HU Jiang, WAN Lun, TANG Liuyi, WANG Yue, YU Yang, ZHANG Wei. Short-term effectiveness comparison between robotic-guided percutaneous minimally invasive pedicle screw internal fixation and traditional open internal fixation in treatment of thoracolumbar fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(1): 76-82. doi: 10.7507/1002-1892.201906105 Copy

1.	Goz V, Weinreb JH, McCarthy I, et al. Perioperative complications and mortality after spinal fusions: analysis of trends and risk factors. Spine (Phila Pa 1976), 2013, 38(22): 1970-1976.
2.	Marcus HJ, Cundy TP, Nandi D, et al. Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review. Eur Spine J, 2014, 23(2): 291-297.
3.	Herren C, Reijnen M, Pishnamaz M, et al. Incidence and risk factors for facet joint violation in open versus minimally invasive procedures during pedicle screw placement in patients with trauma. World Neurosurg, 2018, 112: e711-e718.
4.	Hyun SJ, Kim KJ, Jahng TA, et al. Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions: a randomized controlled trial. Spine (Phila Pa 1976), 2017, 42(6): 353-358.
5.	鐘睿, 王潤生, 劉建恒, 等. 不同入路微創經椎間孔腰椎間融合術治療單節段腰椎管狹窄癥的療效比較. 中國修復重建外科雜志, 2019, 33(7): 807-813.
6.	Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J, 2012, 21(2): 247-255.
7.	楊俊松, 郝定均, 劉團江, 等. 脊柱機器人與透視輔助下經皮植釘治療腰椎滑脫癥中植釘精度的對比研究. 中國修復重建外科雜志, 2018, 32(11): 1371-1376.
8.	Fichtner J, Hofmann N, Rienmüller A, et al. Revision rate of misplaced pedicle screws of the thoracolumbar spine-comparison of three-dimensional fluoroscopy navigation with freehand placement: a systematic analysis and review of the literature. World Neurosurgery, 2018, 109: e24-e32.
9.	Kantelhardt SR, Martinez R, Baerwinkel S, et al. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J, 2011, 20(6): 860-868.
10.	Laudato PA, Pierzchala K, Schizas C. Pedicle screw insertion accuracy using O-Arm, robotic guidance or freehand technique: a comparative study. Spine (Phila Pa 1976), 2018, 43(6): E373-E378.
11.	Joseph JR, Smith BW, Liu X, et al. Current applications of robotics in spine surgery: a systematic review of the literature. Neuro-surgical Focus, 2017, 42(5): E2.
12.	Schr?der ML, Staartjes VE. Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis. Neurosurgical Focus, 2017, 42(5): E12.
13.	Molliqaj G, Schatlo B, Alaid A, et al. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus, 2017, 42(5): E14.
14.	Yu L, Chen X, Margalit A, et al. Robot-assisted vs freehand pedicle screw fixation in spine surgery-a systematic review and a meta analysis of comparative studies. Int J Med Robot, 2018, 14(3): e1892.
15.	Keric N, Eum DJ, Afghanyar F, et al. Evaluation of surgical strategy of conventional vs percutaneous robot-assisted spinal transpedicular instrumentation in spondylodiscitis. J Robot Surg, 2017, 11(1): 17-25.
16.	Kim HJ, Jung WI, Chang BS, et al. A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery. Int J Med Robot, 2017, 13(3).
17.	Archavlis E, Amr N, Kantelhardt SR, et al. Rates of upper facet joint violation in minimally invasive percutaneous and open instrumentation: a comparative cohort study of different insertion techniques. J Neurol Surg A Cent Eur Neurosurg, 2018, 79(1): 1-8.
18.	Teles AR, Paci M, Gutman G, et al. Anatomical and technical factors associated with superior facet joint violation in lumbar fusion. J Neurosurg Spine, 2018, 28(2): 173-180.
19.	Schatlo B, Molliqaj G, Cuvinciuc V, et al. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. J Neurosurg Spine, 2014, 20(6): 636-643.
20.	Takahashi J, Hirabayashi H, Hashidate H, et al. Accuracy of multilevel registration in image-guided pedicle screw insertion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2010, 35(3): 347-352.
21.	Roser F, Tatagiba M, Maier G. Spinal robotics: current applications and future perspectives. Neurosurgery, 2013, 72(Suppl 1): 12-18.
22.	Solomiichuk V, Fleischhammer J, Molliqaj G, et al. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison. Neurosurg Focus, 2017, 42(5): E13.
23.	Park SM, Kim HJ, Lee SY, et al. Radiographic and clinical outcomes of Robot-Assisted posterior pedicle screw fixation: Two-Year results from a randomized controlled trial. Yonsei Med J, 2018, 59(3): 438-444.
24.	Tsai TH, Tzou RD, Su YF, et al. Pedicle screw placement accuracy of bone-mounted miniature robot system. Medicine, 2017, 96(3): e5835.
25.	Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019: 1-8.

1. Goz V, Weinreb JH, McCarthy I, et al. Perioperative complications and mortality after spinal fusions: analysis of trends and risk factors. Spine (Phila Pa 1976), 2013, 38(22): 1970-1976.
2. Marcus HJ, Cundy TP, Nandi D, et al. Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review. Eur Spine J, 2014, 23(2): 291-297.
3. Herren C, Reijnen M, Pishnamaz M, et al. Incidence and risk factors for facet joint violation in open versus minimally invasive procedures during pedicle screw placement in patients with trauma. World Neurosurg, 2018, 112: e711-e718.
4. Hyun SJ, Kim KJ, Jahng TA, et al. Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions: a randomized controlled trial. Spine (Phila Pa 1976), 2017, 42(6): 353-358.
5. 鐘睿, 王潤生, 劉建恒, 等. 不同入路微創經椎間孔腰椎間融合術治療單節段腰椎管狹窄癥的療效比較. 中國修復重建外科雜志, 2019, 33(7): 807-813.
6. Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J, 2012, 21(2): 247-255.
7. 楊俊松, 郝定均, 劉團江, 等. 脊柱機器人與透視輔助下經皮植釘治療腰椎滑脫癥中植釘精度的對比研究. 中國修復重建外科雜志, 2018, 32(11): 1371-1376.
8. Fichtner J, Hofmann N, Rienmüller A, et al. Revision rate of misplaced pedicle screws of the thoracolumbar spine-comparison of three-dimensional fluoroscopy navigation with freehand placement: a systematic analysis and review of the literature. World Neurosurgery, 2018, 109: e24-e32.
9. Kantelhardt SR, Martinez R, Baerwinkel S, et al. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J, 2011, 20(6): 860-868.
10. Laudato PA, Pierzchala K, Schizas C. Pedicle screw insertion accuracy using O-Arm, robotic guidance or freehand technique: a comparative study. Spine (Phila Pa 1976), 2018, 43(6): E373-E378.
11. Joseph JR, Smith BW, Liu X, et al. Current applications of robotics in spine surgery: a systematic review of the literature. Neuro-surgical Focus, 2017, 42(5): E2.
12. Schr?der ML, Staartjes VE. Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis. Neurosurgical Focus, 2017, 42(5): E12.
13. Molliqaj G, Schatlo B, Alaid A, et al. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus, 2017, 42(5): E14.
14. Yu L, Chen X, Margalit A, et al. Robot-assisted vs freehand pedicle screw fixation in spine surgery-a systematic review and a meta analysis of comparative studies. Int J Med Robot, 2018, 14(3): e1892.
15. Keric N, Eum DJ, Afghanyar F, et al. Evaluation of surgical strategy of conventional vs percutaneous robot-assisted spinal transpedicular instrumentation in spondylodiscitis. J Robot Surg, 2017, 11(1): 17-25.
16. Kim HJ, Jung WI, Chang BS, et al. A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery. Int J Med Robot, 2017, 13(3).
17. Archavlis E, Amr N, Kantelhardt SR, et al. Rates of upper facet joint violation in minimally invasive percutaneous and open instrumentation: a comparative cohort study of different insertion techniques. J Neurol Surg A Cent Eur Neurosurg, 2018, 79(1): 1-8.
18. Teles AR, Paci M, Gutman G, et al. Anatomical and technical factors associated with superior facet joint violation in lumbar fusion. J Neurosurg Spine, 2018, 28(2): 173-180.
19. Schatlo B, Molliqaj G, Cuvinciuc V, et al. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. J Neurosurg Spine, 2014, 20(6): 636-643.
20. Takahashi J, Hirabayashi H, Hashidate H, et al. Accuracy of multilevel registration in image-guided pedicle screw insertion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2010, 35(3): 347-352.
21. Roser F, Tatagiba M, Maier G. Spinal robotics: current applications and future perspectives. Neurosurgery, 2013, 72(Suppl 1): 12-18.
22. Solomiichuk V, Fleischhammer J, Molliqaj G, et al. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison. Neurosurg Focus, 2017, 42(5): E13.
23. Park SM, Kim HJ, Lee SY, et al. Radiographic and clinical outcomes of Robot-Assisted posterior pedicle screw fixation: Two-Year results from a randomized controlled trial. Yonsei Med J, 2018, 59(3): 438-444.
24. Tsai TH, Tzou RD, Su YF, et al. Pedicle screw placement accuracy of bone-mounted miniature robot system. Medicine, 2017, 96(3): e5835.
25. Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019: 1-8.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness comparison between robotic-guided percutaneous minimally invasive pedicle screw internal fixation and traditional open internal fixation in treatment of thoracolumbar fractures

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