Yonsei Med J.  2018 May;59(3):438-444. 10.3349/ymj.2018.59.3.438.

Radiographic and Clinical Outcomes of Robot-Assisted Posterior Pedicle Screw Fixation: Two-Year Results from a Randomized Controlled Trial

Affiliations
  • 1Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. highcervical@gmail.com
  • 2Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.

Abstract

PURPOSE
We prospectively assessed the early radiographic and clinical outcomes (minimum follow-up of 2 years) of robot-assisted pedicle screw fixation (Robot-PSF) and conventional freehand pedicle screw fixation (Conv-PSF).
MATERIALS AND METHODS
Patients were randomly assigned to Robot-PSF (37 patients) or Conv-PSF (41 patients) for posterior interbody fusion surgery. The Robot-PSF group underwent minimally invasive pedicle screw fixation using a pre-planned robot-guided screw trajectory. The Conv-PSF underwent screw fixation using the freehand technique. Radiographic adjacent segment degeneration (ASD) was measured on plain radiographs, and clinical outcomes were measured using visual analogue scale (VAS) and Oswestry disability index (ODI) scores regularly after surgery.
RESULTS
The two groups had similar values for radiographic ASD, including University California at Los Angeles grade, vertebral translation, angular motion, and loss of disc height (p=0.320). At final follow-up, both groups had experienced significant improvements in back VAS, leg VAS, and ODI scores after surgery (p < 0.001), although inter-group differences were not significant for back VAS (p=0.876), leg VAS (p=0.429), and ODI scores (p=0.952). In the Conv-PSF group, revision surgery was required for two of the 25 patients (8%), compared to no patients in the Robot-PSF group.
CONCLUSION
There were no significant differences in radiographic ASD and clinical outcomes between Robot-PSF and Conv-PSF. Thus, the advantages of robot-assisted surgery (accurate pedicle screw insertion and minimal facet joint violation) do not appear to be clinically significant.

Keyword

Freehand technique; posterior lumbar interbody fusion; adjacent segment degeneration; robot-assisted pedicle screw fixation

MeSH Terms

California
Follow-Up Studies
Humans
Leg
Pedicle Screws*
Prospective Studies
Zygapophyseal Joint

Figure

  • Fig. 1 CONSORT flow chart. Robot-PSF, robot-assisted pedicle screw fixation; Conv-PSF, conventional freehand pedicle screw fixation.

  • Fig. 2 Graphs showing changes over time between the Robot-PSF and Conv-PSF groups for back and leg pain scores (A and B) and ODI scores (C). There were no significant differences between the groups (p>0.05). Both groups experienced significant improvements from baseline to final follow-up (p<0.05). Error bars indicate 95% confidence intervals. Robot-PSF, robot-assisted pedicle screw fixation; Conv-PSF, conventional freehand pedicle screw fixation; VAS, visual analogue scale; ODI, Oswestry disability index.

  • Fig. 3 A 71-year-old man who was diagnosed with a herniated intervertebral disc at L4–5. (A–C) The L4–5 disc herniation with a collapsed disc was detected during preoperative plain radiography and magnetic resonance imaging. (D) Posterior lumbar interbody fusion was performed using the conventional free-hand technique at L4–5. (E and F) Bony fusion between the cage and endplate in the L4–5 space was observed at the 1-year follow-up. (G and H) After 17 months after the fusion, progressed spinal stenosis was detected at L3–4 with clinical claudication. (I and J) Proximal segment revision surgery at L3–4 was performed with instrumentation and interbody fusion.


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