Abstract
Background Robot-assisted pedicle screw placement is usually performed under general anesthesia to keep the body still. The aim of this study was to compare the accuracy of the robot-assisted technique under regional anesthesia with that of conventional fluoroscopy-guided percutaneous pedicle screw placement under general anesthesia in minimally invasive lumbar fusion surgery. Methods This study recruited patients who underwent robot-assisted percutaneous endoscopic lumbar interbody fusion (PELIF) or fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) between December 2017 and February 2020 at a single center. Based on the method of percutaneous pedicle screw placement used, patients were divided into the robot-assisted under regional anesthesia (group RE-RO) and fluoroscopy-guided under general anesthesia (group GE-FLU) groups. The primary outcome measures were screw accuracy and the incidence of facet joint violation (FJV). Secondary outcome measures included X-ray and visual analogue scale (VAS) scores which were used to evaluate the degree of the postoperative pain at 4 hours and on postoperative days 1, 2, and 3. Intraoperative adverse events were also recorded. Results Eighteen patients were included in group RE-RO, and 23 patients were included in group GE-FLU. The percentages of clinically acceptable screws (Gertzbein and Robbins grades A and B) were 94.4% and 91.5%, respectively. There was no significant difference in the percentages of clinically acceptable screws (p=0.44) or overall Gertzbein and Robbins screw accuracy grades (p=0.35). Only the top screws were included in the analysis of FJVs. The percentages of FJV (Babu grades 1, 2, and 3) were 5.6% and 28.3%, respectively. This difference was statistically significant (p=0.01). Overall, the FJV grades in group RE-RO were significantly better than those in group GE-FLU (p=0.009). The mean fluoroscopy time for each screw in group RE-RO was significantly shorter than that in group GE-FLU (group RE-RO: 5.4 ± 1.9 seconds and group GE-FLU: 6.8 ± 2.0 seconds; p=0.03). The postoperative pain between the RE-RO and GE-FLU groups was not statistically significant. The intraoperative adverse events included 1 case of registration failure and 1 case of guide-wire dislodgment in group RE-RO, as well as 2 cases of screw misplacement in group GE-FLU. No complications related to anesthesia were observed. Conclusion Robot-assisted pedicle screw placement under regional anesthesia can be performed effectively and safely. The accuracy is comparable to the conventional technique. Moreover, this technique has the advantage of fewer FJVs and a lower radiation time.
Highlights
Robot-assisted pedicle screw placement is usually performed under general anesthesia to keep the body still. e aim of this study was to compare the accuracy of the robot-assisted technique under regional anesthesia with that of conventional fluoroscopy-guided percutaneous pedicle screw placement under general anesthesia in minimally invasive lumbar fusion surgery
Patients. is study was approved by the Ethics Committee of the Hebei General Hospital before data collection and analysis. is retrospective study recruited patients with lumbar degenerative disease who underwent robot-assisted percutaneous endoscopic lumbar interbody fusion (PELIF) or fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) between December 2017 and February 2020. e diagnoses included lumbar spinal stenosis, lumbar disc herniation, and lumbar spondylolisthesis. e patients were divided into two groups according to the pedicle screw implantation method: robot-assisted under regional anesthesia and fluoroscopy-guided under general anesthesia
Twenty-three patients (12 women and 11 men) were included in group GE-FLU; 20 patients (9 women and 11 men) underwent MIS-TLIF and 3 women underwent PELIF. e baseline characteristics of age, sex distribution, BMI, the superior facet joint angle, distribution of diagnosis, and screw location did not differ between the groups RE-RO and GE-FLU (Table 2)
Summary
Robot-assisted pedicle screw placement is usually performed under general anesthesia to keep the body still. e aim of this study was to compare the accuracy of the robot-assisted technique under regional anesthesia with that of conventional fluoroscopy-guided percutaneous pedicle screw placement under general anesthesia in minimally invasive lumbar fusion surgery. Based on the method of percutaneous pedicle screw placement used, patients were divided into the robot-assisted under regional anesthesia (group RE-RO) and fluoroscopy-guided under general anesthesia (group GE-FLU) groups. Percutaneous pedicle screw implantation is associated with a high incidence of iatrogenic facet joint violation (FJV), Pain Research and Management which is an independent risk factor for adjacent segment disease (ASD) [2,3,4]. In addition to these patient-related disadvantages, the surgeon’s intraoperative radiation exposure is becoming increasingly concerning [5,6,7]. Previous studies have shown that spinal surgical robots may be able to offer solutions to both of these concerns [8, 9]
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