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Title: [Efficacy comparison of robot-assisted versus freehand fluoroscopy-assisted minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spinal diseases].
Author: Li C, Liu D, Tian YH, Yuan SM, Wang LL, Liu XY.
Journal: Zhonghua Yi Xue Za Zhi; 2024 Oct 08; 104(37):3498-3505. PubMed ID: 39375131.
Abstract:
Objective: To compare the clinical and radiographic outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) and fluoroscopy-assisted MIS-TLIF (FA MIS-TLIF) in patients with degenerative lumbar spinal diseases. Methods: The clinical data of 114 patients with lumbar degenerative diseases who underwent MIS-TLIF in Qilu Hospital of Shandong University from January 2019 to March 2022 were analyzed retrospectively. Fifty-eight patients underwent RA MIS-TLIF (robot group) and 56 patients received FA MIS-TLIF (freehand group). There were 16 males and 42 females in the robot group, with a mean age of (56.7±8.1) years. And there were 19 males and 37 females in the freehand group, with a mean age of (57.2±8.6) years. The clinical outcome parameters were the visual analog scale (VAS) of pain, Oswestry Disability Index (ODI) score, operative time, number of intraoperative fluoroscopies, blood loss, postoperative hospital stay and complications. The radiographic change measures were the accuracy of screw placement, facet joint violation (FJV), fusion status, and change in disc height at the proximal adjacent segment. All the patients were followed-up for 2-5 years. Results: There was no significant differences in the VAS and ODI scores, blood loss, or postoperative hospital stay between the two groups (all P>0.05). The operative time was longer in robot group than freehand group [(158.5±12.1) min vs (146.4±15.4) min, P<0.001]. There was no significant difference in the number of intraoperative fluoroscopies for patients between robot group and freehand group (P>0.05). The number of intraoperative fluoroscopies for the surgeon was significantly lower in robot group than freehand group (13.8±3.9 vs 74.7±6.8, P<0.001). The rate of a perfect screw position (grade A) was higher in robot group than freehand group [87.5%(203/232) vs 70.1%(157/224), P<0.001]. However, there was no significant difference in the proportion of clinically acceptable screws (grades A and B) between the two groups [98.3%(228/232) vs 96.9%(217/224), P=0.330]. The FJV grade was significantly higher in freehand group than robot group (0.43±0.68 vs 0.13±0.43, P<0.001). During at 2-year postoperative follow-up, there was no significant difference in the fusion status between the two groups (P>0.05); however, the decrease in disc height at the proximal adjacent segment was significantly less in robot group than freehand group [(0.63±0.38) mm vs (0.92±0.35) mm, P=0.001]. In the robotic group, a pedicle screw penetrated the outer wall of the vertebral pedicle in one patient, which was adjusted during surgery. In the freehand group, two screws were inserted too deeply and penetrated the anterior cortex, resulting in mild abdominal discomfort postoperatively, which resolved by the third day after surgery. Conclusions: Robot-assisted percutaneous pedicle screw placement is a safer and more accurate alternative to conventional freehand fluoroscopy-assisted pedicle screw insertion in MIS-TLIF. Compared with freehand MIS-TLIF, robot-assisted MIS-TLIF increases the operation time, but the accuracy of screw placement is higher, and the intraoperative radiation dose and the degree of adjacent segment degeneration are reduced. 目的： 比较机器人和徒手透视辅助下微创经椎间孔入路腰椎椎体间融合术（MIS-TLIF）对退行性腰椎病的临床疗效。 方法： 回顾性分析2019年1月至2022年3月114例在山东大学齐鲁医院接受MIS-TLIF的腰椎退行性疾病患者的临床资料。根据手术方式不同将患者分为2组：58例患者接受了机器人辅助下MIS-TLIF，为机器人组，其中男16例，女42例女性；年龄为（56.7±8.1）岁；56例患者接受了徒手透视下MIS-TLIF，为徒手组，其中男19例，女37例，年龄为（57.2±8.6）岁。比较两组治疗效果，包括手术前后疼痛视觉模拟评分（VAS）、Oswestry残疾指数（ODI）、手术时间、术中透视次数、术中出血量、术后住院时间和术后并发症。分析比较两组影像学指标，包括螺钉放置的准确性、关节突关节侵扰（FJV）、融合状态以及邻近节段的椎间盘高度变化。所有患者术后随访2~5年，内容包括临床疗效及影像学。 结果： 机器人组和徒手组在术前及术后VAS和ODI评分、失血量和术后住院时间等方面差异均无统计学意义（均P>0.05）。机器人组的手术时间比徒手组长［（158.5±12.1）min比（146.4±15.4）min，P<0.001］。机器人组和徒手组患者的术中透视次数差异无统计学意义（P>0.05）。机器人组医师的术中透视次数低于徒手组［（13.8±3.9）次比（74.7±6.8）次，P<0.001］。机器人组A级螺钉置入准确率高于徒手组［87.5%（203/232）比70.1%（157/224），P<0.001］，而临床可接受的螺钉置入比例（A和B级）两组间差异无统计学意义［98.3%（228/232）比96.9%（217/224），P=0.330］。徒手组FJV分级明显高于机器人组（0.43±0.68比0.13±0.43，P<0.001）。在术后的随访中，两组间椎间融合状态差异无统计学意义（P>0.05）；但机器人组近端邻近节段的椎间高度下降小于徒手组［（0.63±0.38）mm比（0.92±0.35）mm，P=0.001］。机器人组1例患者的椎弓根螺钉穿透了椎弓根外壁，术中做了相应调整。徒手组有2枚螺钉置入过深穿透前方皮质，术后出现轻度腹部不适，于术后3 d缓解。 结论： 与徒手透视MIS-TLIF相比，机器人辅助MIS-TLIF是一种更安全有效的选择，虽增加了手术时间，但其置钉准确性更高，且减少了医师术中辐射剂量以及邻近节段的退变程度。.

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