Abstract
Study designA single-institution, retrospective cohort study.ObjectiveTo compare the accuracy and short-term clinical outcomes of pedicle screw placement between robot-assisted (RA) and freehand (FH) technique in the treatment of adult degenerative scoliosis (ADS).MethodsFrom February 2018 to October 2019, 97 adult patients with degenerative scoliosis admitted to our department were retrospectively reviewed. Thirty-one patients received robot-assisted pedicle screw placement (RA group), and 66 patients underwent freehand pedicle screw placement (FH group). Patient demographics and short-term clinical outcomes were recorded and compared between two groups. Gertzbein-Robbins grading system was adopted to evaluate the accuracy of pedicle screw placement by means of postoperative CT scan. Short-term clinical outcomes consist of operative time, intraoperative blood loss, length of hospital stay (LOS), radiological parameters, Scoliosis Research Society-22 (SRS-22) scores before the operation, 6 months after operation, adverse events, and revisions.ResultsThe accuracy of screw placement was higher than that of the FH group (clinically acceptable 98.7% vs. 92.2%; P< 0.001). Intraoperative blood loss of the RA group was less than those in the FH group (499 vs. 573 ml; P < 0.001). Operative time (283.1 vs. 291.9 min; P = 0.31) and length of stay (12.8 vs. 13.7 days; P = 0.36) were compared between RA and FH groups. In terms of radiological parameters, both of groups were improved postoperatively. The SRS-22 scores at 6 months after operation from both groups were better than those before operation. For surgery-related complication, one case had pressure sores in the RA group while two cases developed dural tears in the FH group. No revision was required in both groups.ConclusionCombined with other surgical correction modalities, robot-assisted pedicle screw fixation is an effective and safe method of treating degenerative scoliosis. Due to its satisfactory surgical outcomes such as higher accuracy and less trauma, it provides a good alternative for clinical practice.Level of evidence3.
Highlights
Adult degenerative scoliosis, called adult “De Novo” scoliosis, is characterized by a spinal column deformity (Cobb angle> 10° in coronal plain) due to osteoporosis and progressive degeneration of spinal apparatus such as facet joint arthrosis and disc degeneration [1,2,3]
Adverse factors such as osteoporosis, spinal stenosis, severe degeneration of facet joints, pedicle rotation, and sclerosis have greatly increased the difficulty of screw placement
The inclusion criteria were as follows: (1) degenerative scoliosis continuously evolved on the basis of precedent scoliosis with imbalance in the sagittal or coronal planes, which required screw fixation; (2) age ranging from 45 to 80 years old; and (3) patients complied with study
Summary
Called adult “De Novo” scoliosis, is characterized by a spinal column deformity (Cobb angle> 10° in coronal plain) due to osteoporosis and progressive degeneration of spinal apparatus such as facet joint arthrosis and disc degeneration [1,2,3]. Pedicle screw fixation plays an important role in the correction of deformity [5]. Adverse factors such as osteoporosis, spinal stenosis, severe degeneration of facet joints, pedicle rotation, and sclerosis have greatly increased the difficulty of screw placement. In order to reduce the unfavorable factors such as the loosening of the trajectory, deformity surgery requires extremely high surgical skills from doctors, who should strive for a successful screw placement at the first attempt
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