A comparative study on treatment of lumbar degenerative disease with osteoporosis by manual and robot-assisted cortical bone trajectory screws fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Haojie ^1,2 , LIU Shichang ² , ZHANG Jianan ² , YANG Junsong ² , HAO Dingjun ² , ZHAO Shuai ¹ , ZHANG Zilong ¹ , YANG Jiarui ¹ , QIAO Rui ¹ ,  HUANG Xiaoqiang ²

1. Xi’an Medical University, Xi’an Shaanxi, 710068, P.R.China;
2. Department of Orthopedics, Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an Shanxi, 710054, P.R.China;

Corresponding?author：

HUANG Xiaoqiang, Email: 18700828311@163.com

Keywords：

Robot; osteoporosis; lumbar degenerative disease; accuracy of screw placement; cortical bone trajectory screw

DOI：

10.7507/1002-1892.202001070

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Objective To compare the safety and accuracy of manual and robot-assisted cortical bone trajectory (CBT) screws fixation in the treatment of lumbar degenerative diseases with osteoporosis.Methods The clinical data of 58 cases of lumbar degenerative disease with osteoporosis treated by CBT screw fixation between February 2017 and February 2019 were analyzed retrospectively. Among them, 29 cases were fixed with CBT screws assisted by robot (group A), 29 cases were fixed with CBT screws by hand (group B). There was no significant difference between the two groups in terms of gender, age, body mass index, lesion type, T-value of bone mineral density, and operative segment (P>0.05), with comparability. The accuracy of implant was evaluated by Kaito’s grading method, and the invasion of CBT screw to the superior articular process was evaluated by Babu’s method.Results The operation time and intraoperative blood loss in group A were significantly less than those in group B (t=?8.921, P=0.000; t=?14.101, P=0.000). One hundred and sixteen CBT screws were implanted in the two groups. At 3 days after operation, according to the Kaito’s grading method, the accuracy of implant in group A was 108 screws of grade 0, 6 of grade 1, and 2 of grade 2; and in group B was 86 screws of grade 0, 12 of grade 1, and 18 of grade 2; the difference was significant (Z=4.007, P=0.000). There were 114 accepted screws (98.3%) in group A and 98 (84.5%) in group B, the difference was significant (χ²=8.309, P=0.009). At 3 days after operation, according to Babu’s method, there were 85 screws in grade 0, 3 in grade 1, and 2 in grade 2 in group A; and in group B, there were 91 screws in grade 0, 16 in grade 1, 5 in grade 2, and 4 in grade 3; the difference was significant (Z=7.943, P=0.000). No serious injury of spinal cord, nerve, and blood vessel was found in the two groups. One patient in group A had delayed cerebrospinal fluid leakage, and 2 patients in group B had mild anemia. Both groups were followed up 10-14 months (mean, 11.6 months). The neurological symptoms were improved, and no screw loosening or fracture was found during the follow-up.Conclusion Compared with manual implantation of CBT screw, robot-assisted spinal implant has higher accuracy, lower incidence of invasion of superior articular process, and strong holding power of CBT screw, which can be applied to the treatment of lumbar degenerative diseases with osteoporosis.

Citation： CHEN Haojie, LIU Shichang, ZHANG Jianan, YANG Junsong, HAO Dingjun, ZHAO Shuai, ZHANG Zilong, YANG Jiarui, QIAO Rui, HUANG Xiaoqiang. A comparative study on treatment of lumbar degenerative disease with osteoporosis by manual and robot-assisted cortical bone trajectory screws fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1142-1148. doi: 10.7507/1002-1892.202001070 Copy

1.	El Saman A, Meier S, Sander A, et al. Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly. Eur J Trauma Emerg Surg, 2013, 39(5): 455-460.
2.	白璧輝, 謝興文, 李鼎鵬, 等. 我國近 5 年來骨質疏松癥流行病學研究現狀. 中國骨質疏松雜志, 2018, 24(2): 253-258.
3.	Skinner R, Maybee J, Transfeldt E, et al. Experimental pullout testing and comparison of variables in transpedicular screw fixation. A biomechanical study. Spine (Phila Pa 1976), 1990, 15(3): 195-201.
4.	Chang MC, Liu CL, Chen TH. Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine (Phila Pa 1976), 2008, 33(10): E317-E324.
5.	Santoni BG, Hynes RA, McGilvray KC, et al. Cortical bone trajectory for lumbar pedicle screws. Spine J, 2009, 9(5): 366-373.
6.	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.
7.	Kaito T, Matsukawa K, Abe Y, et al. Cortical pedicle screw placement in lumbar spinal surgery with a patient-matched targeting guide: A cadaveric study. J Orthop Sci, 2018, 23(6): 865-869.
8.	Babu R, Park JG, Mehta AI, et al. Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement. Neurosurgery, 2012, 71(5): 962-970.
9.	Matsukawa K, Yato Y, Imabayashi H, et al. Biomechanical evaluation of lumbar pedicle screws in spondylolytic vertebrae: comparison of fixation strength between the traditional trajectory and a cortical bone trajectory. J Neurosurg Spine, 2016, 24(6): 910-915.
10.	Matsukawa K, Yato Y, Kato T, et al. In vivo analysis of insertional torque during pedicle screwing using cortical bone trajectory technique. Spine (Phila Pa 1976), 2014, 39(4): E240-E245.
11.	Kojima K, Asamoto S, Kobayashi Y, et al. Cortical bone trajectory and traditional trajectory—a radiological evaluation of screw-bone contact. Acta Neurochir (Wien), 2015, 157(7): 1173-1178.
12.	金海明, 徐道亮, 潘翔翔, 等. 椎弓根皮質骨螺釘固定與傳統椎弓根螺釘固定釘道周圍骨質 CT 值比較. 中國脊柱脊髓雜志, 2016, 26(12): 1115-1120.
13.	楊民毅, 劉西紡, 劉世長, 等. 皮質骨螺釘通道技術在骨質疏松腰椎退行性疾病中的應用. 實用骨科雜志, 2019, 25(3): 245-249.
14.	錢立雄, 郝定均, 孫宏慧, 等. 骨水泥強化椎弓根螺釘固定與皮質骨軌跡螺釘固定治療腰椎退變性疾病合并骨質疏松的效果比較. 臨床醫學研究與實踐, 2019, 4(13): 87-90.
15.	Ueno M, Imura T, Inoue G, et al. Posterior corrective fusion using a double-trajectory technique (cortical bone trajectory combined with traditional trajectory) for degenerative lumbar scoliosis with osteoporosis: technical note. J Neurosurg Spine, 2013, 19(5): 600-607.
16.	Takata Y, Matsuura T, Higashino K, et al. Hybrid technique of cortical bone trajectory and pedicle screwing for minimally invasive spine reconstruction surgery: a technical note. J Med Invest, 2014, 61(3-4): 388-392.
17.	沈為光, 何伯圣, 龔沈初. 腰椎后路固定融合術后鄰近節段退變的研究進展. 醫學綜述, 2019, 25(14): 2832-2836.
18.	李超, 阮狄克, 何勍, 等. 腰椎減壓融合術中保留頭端后部韌帶復合體結構完整性對相鄰節段退變的影響. 脊柱外科雜志, 2016, 14(5): 262-266.
19.	Wang H, Ma L, Yang D, et al. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion. Medicine (Baltimore), 2016, 95(32): e4443.
20.	Etebar S, Cahill DW. Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg, 1999, 90(2 Suppl): 163-169.
21.	Min JH, Jang JS, Jung BJ, et al. The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. J Spinal Disord Tech, 2008, 21(5): 305-309.
22.	Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976), 2007, 32(3): E111-E120.
23.	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.
24.	田野, 張嘉男, 陳浩, 等. 脊柱機器人與傳統透視輔助下微創經皮復位內固定術治療單節段無神經癥狀胸腰椎骨折對比研究. 中國修復重建外科雜志, 2020, 34(1): 69-75.

1. El Saman A, Meier S, Sander A, et al. Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly. Eur J Trauma Emerg Surg, 2013, 39(5): 455-460.
2. 白璧輝, 謝興文, 李鼎鵬, 等. 我國近 5 年來骨質疏松癥流行病學研究現狀. 中國骨質疏松雜志, 2018, 24(2): 253-258.
3. Skinner R, Maybee J, Transfeldt E, et al. Experimental pullout testing and comparison of variables in transpedicular screw fixation. A biomechanical study. Spine (Phila Pa 1976), 1990, 15(3): 195-201.
4. Chang MC, Liu CL, Chen TH. Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine (Phila Pa 1976), 2008, 33(10): E317-E324.
5. Santoni BG, Hynes RA, McGilvray KC, et al. Cortical bone trajectory for lumbar pedicle screws. Spine J, 2009, 9(5): 366-373.
6. 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.
7. Kaito T, Matsukawa K, Abe Y, et al. Cortical pedicle screw placement in lumbar spinal surgery with a patient-matched targeting guide: A cadaveric study. J Orthop Sci, 2018, 23(6): 865-869.
8. Babu R, Park JG, Mehta AI, et al. Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement. Neurosurgery, 2012, 71(5): 962-970.
9. Matsukawa K, Yato Y, Imabayashi H, et al. Biomechanical evaluation of lumbar pedicle screws in spondylolytic vertebrae: comparison of fixation strength between the traditional trajectory and a cortical bone trajectory. J Neurosurg Spine, 2016, 24(6): 910-915.
10. Matsukawa K, Yato Y, Kato T, et al. In vivo analysis of insertional torque during pedicle screwing using cortical bone trajectory technique. Spine (Phila Pa 1976), 2014, 39(4): E240-E245.
11. Kojima K, Asamoto S, Kobayashi Y, et al. Cortical bone trajectory and traditional trajectory—a radiological evaluation of screw-bone contact. Acta Neurochir (Wien), 2015, 157(7): 1173-1178.
12. 金海明, 徐道亮, 潘翔翔, 等. 椎弓根皮質骨螺釘固定與傳統椎弓根螺釘固定釘道周圍骨質 CT 值比較. 中國脊柱脊髓雜志, 2016, 26(12): 1115-1120.
13. 楊民毅, 劉西紡, 劉世長, 等. 皮質骨螺釘通道技術在骨質疏松腰椎退行性疾病中的應用. 實用骨科雜志, 2019, 25(3): 245-249.
14. 錢立雄, 郝定均, 孫宏慧, 等. 骨水泥強化椎弓根螺釘固定與皮質骨軌跡螺釘固定治療腰椎退變性疾病合并骨質疏松的效果比較. 臨床醫學研究與實踐, 2019, 4(13): 87-90.
15. Ueno M, Imura T, Inoue G, et al. Posterior corrective fusion using a double-trajectory technique (cortical bone trajectory combined with traditional trajectory) for degenerative lumbar scoliosis with osteoporosis: technical note. J Neurosurg Spine, 2013, 19(5): 600-607.
16. Takata Y, Matsuura T, Higashino K, et al. Hybrid technique of cortical bone trajectory and pedicle screwing for minimally invasive spine reconstruction surgery: a technical note. J Med Invest, 2014, 61(3-4): 388-392.
17. 沈為光, 何伯圣, 龔沈初. 腰椎后路固定融合術后鄰近節段退變的研究進展. 醫學綜述, 2019, 25(14): 2832-2836.
18. 李超, 阮狄克, 何勍, 等. 腰椎減壓融合術中保留頭端后部韌帶復合體結構完整性對相鄰節段退變的影響. 脊柱外科雜志, 2016, 14(5): 262-266.
19. Wang H, Ma L, Yang D, et al. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion. Medicine (Baltimore), 2016, 95(32): e4443.
20. Etebar S, Cahill DW. Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg, 1999, 90(2 Suppl): 163-169.
21. Min JH, Jang JS, Jung BJ, et al. The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. J Spinal Disord Tech, 2008, 21(5): 305-309.
22. Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976), 2007, 32(3): E111-E120.
23. 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.
24. 田野, 張嘉男, 陳浩, 等. 脊柱機器人與傳統透視輔助下微創經皮復位內固定術治療單節段無神經癥狀胸腰椎骨折對比研究. 中國修復重建外科雜志, 2020, 34(1): 69-75.

Chinese Journal of Reparative and Reconstructive Surgery

A comparative study on treatment of lumbar degenerative disease with osteoporosis by manual and robot-assisted cortical bone trajectory screws fixation

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