Effects of robot-assisted percutaneous minimally invasive pedicle screw placement in oblique lumbar interbody fusion

doi:10.12307/2022.067

Abstract

Abstract: BACKGROUND: The technique of oblique lumbar interbody fusion has become increasingly mature, but when pedicle screw internal fixation is performed through posterior approach, the fluoroscopy-assisted pedicle screw insertion using a traditional open technique still brings greater trauma to the patient. With the advancement of technology, robot-assisted surgery systems have provided clinicians with new options.
OBJECTIVE: To explore the clinical outcomes of percutaneous robot-assisted minimally invasive pedicle screw insertion in an oblique lumbar interbody fusion procedure.
METHODS: Totally 78 patients with lumbar degenerative disease who attended Department of Spinal Surgery, Beijing Jishuitan Hospital were treated with oblique lumbar interbody fusion. When lumbar pedicle screw internal fixation was performed through posterior approach, 36 cases (trial group) underwent percutaneous robot-assisted minimally invasive pedicle screw insertion, and 42 cases (control group) underwent fluoroscopy-assisted open invasive screw insertion. The difference in operation time, visual analogue scale score, Oswestry disability index, intraoperative and postoperative blood loss was compared between the two groups.
RESULTS AND CONCLUSION: The operative time of trial group was shorter than that of control group (P < 0.05). The postoperative visual analogue scale score of the trial group was lower than that of the control group (P < 0.05). The amount of intraoperative and postoperative blood loss in the trial group was less than that in the control group (P < 0.05). It is concluded that robot-assisted pedicle screw insertion in oblique lumbar interbody fusion can shorten the operative time, reduce intraoperative blood loss, lessen risk of surgical complications, and reduce the soft tissue damage of lumbar spine.

Key words: oblique, lumbar, interbody fusion, robot, percutaneous, minimally invasive, pedicle screw

CLC Number:

Feng Shuo, Liu Bo, He Da. Effects of robot-assisted percutaneous minimally invasive pedicle screw placement in oblique lumbar interbody fusion[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(3): 408-413.

Figures/Tables 4

2.5 Oswestry 功能障碍指数术前试验组和对照组Oswestry 功能障碍指数分别为(68.86±5.95)%和(68.98±7.09)%，差异无显著性意义(P > 0.05)。术后试验组和对照组Oswestry 功能障碍指数分别为(19.86±5.45)%和(21.01±5.57)%，差异无显著性意义(P > 0.05)。术后6个月随访时试验组和对照组Oswestry 功能障碍指数分别为(15.10±4.99)%和(15.36±5.02)%，差异无显著性意义(P > 0.05)，见表3。 2.6 手术时长试验组平均手术时长为(175.15±58.55) min，对照组平均手术时长为(211.68 ± 55.62) min，差异有显著性意义(P < 0.05)。试验组前路平均手术时长为(80.78± 35.84) min，对照组前路平均手术时长为(78.75±28.35) min，差异无显著性意义(P > 0.05)。试验组后路平均手术时长为(79.17±29.96) min，对照组后路平均手术时长为(112.58± 29.01) min，差异有显著性意义(P < 0.05)，见表3。 2.7 术中出血量和术后引流量试验组术中出血量为(155.08±99.01) mL，对照组术中出血量为(226.22±155.87) mL，差异有显著性意义(P < 0.05)。对照组术后引流量为(280.33 ± 132.50) mL，试验组为0 mL，见表3。 2.8 并发症试验组有1例左侧屈髋乏力；对照组有1例左侧屈髋乏力，1例术后CT示螺钉位置失准，进入椎管，一期行翻修手术后无异常。所有并发症均在术后1个月左右完全恢复。 2.9 生物相容性两组患者均未出现与植入材料有关的不良反应。 2.10 典型病例分析患者女，68岁，主因“左下肢放射性麻痛伴间歇性跛行半年”入院，诊断为“腰椎间盘突出，腰椎管狭窄”，完善相关检查后，行斜外侧腰椎椎间融合术，术中行后路椎弓根螺钉内固定，在骨科机器人工作站精确规划螺钉轨迹，并在机器人辅助下置入椎弓根螺钉，透视螺钉位置满意；术后CT可见椎间隙高度恢复满意，椎管和侧隐窝狭窄减轻，双侧神经根压迫解除，椎弓根螺钉及椎间融合器位置满意。见图4。"

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