A comparative study of robot assisted insertion and traditional free-hand pedicle screw technique
CHEN Long
HAI Yong
GUAN Li
LIU Yu-zeng
SU Qing-jun
YANG Jin-cai
KANG Nan
MENG Xiang-long
CHEN Xiao-long
Abstract：Objective To evaluate the clinical application of Renaissance robotic-assisted system for spinal pedicle screw insertion, to compare the placement accuracy & safety of robotic-assisted insertion with traditional free-hand technique. Methods This was a perspective controlled trial. Twenty consecutive patients ( 11 males, 9 females ) with spinal disorders, who underwent pedicle screws insertion between December 2015 and March 2016, were enrolled in the robotic-assisted group. The mean age was 54.1 years ( range: 11 - 85 years ). Twenty consecutive patients ( 6 males, 14 females ) were enrolled in the traditional free-hand group. The mean age was 54.8 years ( range: 18 -75 years ). Whole spinal 1.0 mm CT scan was used for all patients. Renaissance robotic-assisted system was used in the robotic-assisted group for preoperative planning. Intraoperative fluoroscopy was applied to match the information with the robotic-assisted system during the procedure. Times of intraoperative fluoroscopy and time of each pedicle screw placement were recorded. Postoperative whole spinal CT scan was applied to check the position of pedicle screws. Data were statistically compared. Results A total of 394 pedicle screws were successfully implanted. Actually 124 pedicle screws were implanted with robotic-assist ( robotic-assist was aborted and 24 screws were manually placed ). Average times for intraoperative fluoroscopy per procedure were ( 7.0 ± 2.5 ) in the robotic-assisted group ( platform mounting and registration ), and average ( 12.6 ± 4.5 ) times for intraoperative fluoroscopy per procedure in hand-free group ( P < 0.05 ). Average ( 18.9 ± 7.2 ) min for mounting the platform and registration. Average ( 3.7 ± 1.5 ) min to insert each screw in the robotic-assisted group, and average ( 4.3 ± 0.8 ) min to insert each screw in the hand-free group ( P > 0.05 ). Intraoperative fluoroscopy and postoperative CT scan showed all screws were placed into the pedicle accurately with robotic-assist. According to Dr. Rampersaud classification, 124 screws were graded as A in the robotic-assisted group. Total 198 screws were graded as A, 28 were graded as B, 16 were graded as C, 4 were graded as D in traditional hand-free group. The accuracy rate was 91.8% ( including grade A and B ) with statistical significance ( P = 0.032 ). Average operation time of the robotic-assisted group was ( 268.3 ± 74.0 ) min, while free-hand group ( 267.5 ± 65.3 ) min with no statistical significance ( P = 0.980 ). Average blood loss of robotic-assisted group was ( 285.0 ± 240.2 ) ml, while ( 640.0 ± 389.3 ) ml in the free-hand group with statistical significance ( P = 0.031 ). Conclusions Robotic-assisted system improves the accuracy of implant and the safety of spinal surgery. The times and radiation dosage of intraoperative fluoroscopy are reduced. It is of a great prospect to be applied not only in spinal percutaneous surgery, but also revision and deformity.
Keywords：Spinal diseasesPedicle screwsSurgerycomputer-assistedRobotics
Publication Date：2017-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 730-736 )