Effect of Robot-Assisted Surgery on Lumbar Pedicle Screw Internal Fixation in Patients with Osteoporosis

Abstract

We sought to compare clinical outcomes of robot-assisted versus conventional freehand fluoroscopy-assisted lumbar pedicle screw insertion in patients with osteoporosis. This study included 80 patients with osteoporosis and lumbar disease treated with pedicle screw internal fixation in the Department of Spine Surgery, Beijing Jishuitan Hospital between June 2016 and July 2018. Patients were randomly assigned to receive either robot-assisted pedicle screw insertion (experimental group) or freehand fluoroscopy-assisted pedicle screw insertion (control group). The accuracy of screw placement was assessed with postoperative computed tomography. Operative time, pedicle screw placement time, radiation exposure to the medical team, and intraoperative blood loss were recorded. A total of 427 pedicle screws were inserted in 80 patients; 202 pedicle screws were placed in the experimental group, and 225 pedicle screws were placed in the control group. The accuracy of screw placement was significantly higher with robot-assisted pedicle screw insertion (98.5% [199/202]) compared with that achieved with the freehand technique (91.6% [206/225]) (P < 0.05). Robot-assisted pedicle screw insertion was associated with reductions in the mean total pedicle screw placement time (27.60 ± 8.58 vs. 32.26 ± 10.48 minutes), radiation exposure to the medical team (2.23 ± 0.62 vs. 3.35 ± 0.80 fluoroscopic images), and intraoperative blood loss (254.75± 115.34 vs. 356.25 ± 141.00 mL; P < 0.05). The meanoperative time did not differ significantly between the groups. Robot-assisted pedicle screw insertion is a more effective surgical option for patients with osteoporosis who present with various spine diseases compared with fluoroscopy-assisted freehand screw placement techniques.