Journal of Korean Neurosurgical Society

  • 제67권1호
  • /
  • Pages.60-72
  • /
  • 2024
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

A Single-Center Experience of Robotic-Assisted Spine Surgery in Korea : Analysis of Screw Accuracy, Potential Risk Factor of Screw Malposition and Learning Curve

  • Bu Kwang Oh (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Dong Wuk Son (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Jun Seok Lee (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Su Hun Lee (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Young Ha Kim (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Soon Ki Sung (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Sang Weon Lee (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Geun Sung Song (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Seong Yi (Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital)
  • 투고 : 2023.06.20
  • 심사 : 2023.07.31
  • 발행 : 2024.01.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : Recently, robotic-assisted spine surgery (RASS) has been considered a minimally invasive and relatively accurate method. In total, 495 robotic-assisted pedicle screw fixation (RAPSF) procedures were attempted on 100 patients during a 14-month period. The current study aimed to analyze the accuracy, potential risk factors, and learning curve of RAPSF. Methods : This retrospective study evaluated the position of RAPSF using the Gertzbein and Robbins scale (GRS). The accuracy was analyzed using the ratio of the clinically acceptable group (GRS grades A and B), the dissatisfying group (GRS grades C, D, and E), and the Surgical Evaluation Assistant program. The RAPSF was divided into the no-breached group (GRS grade A) and breached group (GRS grades B, C, D, and E), and the potential risk factors of RAPSF were evaluated. The learning curve was analyzed by changes in robot-used time per screw and the occurrence tendency of breached and failed screws according to case accumulation. Results : The clinically acceptable group in RAPSF was 98.12%. In the analysis using the Surgical Evaluation Assistant program, the tip offset was 2.37±1.89 mm, the tail offset was 3.09±1.90 mm, and the angular offset was 3.72°±2.72°. In the analysis of potential risk factors, the difference in screw fixation level (p=0.009) and segmental distance between the tracker and the instrumented level (p=0.001) between the no-breached and breached group were statistically significant, but not for the other factors. The mean difference between the no-breach and breach groups was statistically significant in terms of pedicle width (p<0.001) and tail offset (p=0.042). In the learning curve analysis, the occurrence of breached and failed screws and the robot-used time per screw screws showed a significant decreasing trend. Conclusion : In the current study, RAPSF was highly accurate and the specific potential risk factors were not identified. However, pedicle width was presumed to be related to breached screw. Meanwhile, the robot-used time per screw and the incidence of breached and failed screws decreased with the learning curve.

키워드

참고문헌

  1. Ahern DP, Gibbons D, Schroeder GD, Vaccaro AR, Butler JS : Imageguidance, robotics, and the future of spine surgery. Clin Spine Surg 33 : 179-184, 2020 https://doi.org/10.1097/BSD.0000000000000809
  2. Attar A, Ugur HC, Uz A, Tekdemir I, Egemen N, Genc Y : Lumbar pedicle: surgical anatomic evaluation and relationships. Eur Spine J 10 : 10-15, 2001 https://doi.org/10.1007/s005860000198
  3. Avrumova F, Morse KW, Heath M, Widmann RF, Lebl DR : Evaluation of K-wireless robotic and navigation assisted pedicle screw placement in adult degenerative spinal surgery: learning curve and technical notes. J Spine Surg 7 : 141-154, 2021 https://doi.org/10.21037/jss-20-687
  4. Broadbent E, Kuo IH, Lee YI, Rabindran J, Kerse N, Stafford R, et al. : Attitudes and reactions to a healthcare robot. Telemed J E Health 16 : 608-613, 2010 https://doi.org/10.1089/tmj.2009.0171
  5. Bydon M, Chen SG, Neal MD, Krishna C, Biedermann AJ, Paul TC, et al. : Initiation of a robotic program in spinal surgery: experience at a threesite medical center. Mayo Clin Proc 96 : 1193-1202, 2021 https://doi.org/10.1016/j.mayocp.2020.07.034
  6. Castro E Melo JAGME, Faria Araujo NM : Impact of the fourth industrial revolution on the health sector: a qualitative study. Healthc Inform Res 26 : 328-334, 2020 https://doi.org/10.4258/hir.2020.26.4.328
  7. Cook SD, Salkeld SL, Whitecloud TS 3rd, Barbera J : Biomechanical evaluation and preliminary clinical experience with an expansive pedicle screw design. J Spinal Disord 13 : 230-236, 2000 https://doi.org/10.1097/00002517-200006000-00006
  8. D'Souza M, Gendreau J, Feng A, Kim LH, Ho AL, Veeravagu A : Roboticassisted spine surgery: history, efficacy, cost, and future trends. Robot Surg 6 : 9-23, 2019 https://doi.org/10.2147/RSRR.S190720
  9. Fan Y, Peng Du J, Liu JJ, Zhang JN, Liu SC, Hao DJ : Radiological and clinical differences among three assisted technologies in pedicle screw fixation of adult degenerative scoliosis. Sci Rep 8 : 890, 2018 https://doi.org/10.1038/s41598-017-19054-7
  10. Gao S, Lv Z, Fang H : Robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis of randomized controlled trials. Eur Spine J 27 : 921-930, 2018 https://doi.org/10.1007/s00586-017-5333-y
  11. Gosrisirikul C, Don Chang K, Raheem AA, Rha KH : New era of robotic surgical systems. Asian J Endosc Surg 11 : 291-299, 2018 https://doi.org/10.1111/ases.12660
  12. Ho C, Tsakonas E, Tran K, Cimon K, Severn M, Mierzwinski-Urban M, et al. : Robot-assisted surgery compared with open surgery and laparoscopic surgery. CADTH Technol Overv 2 : e2203, 2012
  13. Hu X, Lieberman IH : What is the learning curve for robotic-assisted pedicle screw placement in spine surgery? Clin Orthop Relat Res 472 : 1839-1844, 2014 https://doi.org/10.1007/s11999-013-3291-1
  14. Huang M, Tetreault TA, Vaishnav A, York PJ, Staub BN : The current state of navigation in robotic spine surgery. Ann Transl Med 9 : 86, 2021 https://doi.org/10.21037/atm-2020-ioi-07
  15. Jiang B, Pennington Z, Azad T, Liu A, Ahmed AK, Zygourakis CC, et al. : Robot-assisted versus freehand instrumentation in short-segment lumbar fusion: experience with real-time image-guided spinal robot. World Neurosurg 136 : e635-e645, 2020 https://doi.org/10.1016/j.wneu.2020.01.119
  16. Khan A, Meyers JE, Siasios I, Pollina J : Next-generation robotic spine surgery: first report on feasibility, safety, and learning curve. Oper Neurosurg (Hagerstown) 17 : 61-69, 2019 https://doi.org/10.1093/ons/opy280
  17. Kim HJ, Lee SH, Chang BS, Lee CK, Lim TO, Hoo LP, et al. : Monitoring the quality of robot-assisted pedicle screw fixation in the lumbar spine by using a cumulative summation test. Spine (Phila Pa 1976) 40 : 87- 94, 2015 https://doi.org/10.1097/BRS.0000000000000680
  18. Kuo LJ, Lin YK, Chang CC, Tai CJ, Chiou JF, Chang YJ : Clinical outcomes of robot-assisted intersphincteric resection for low rectal cancer: comparison with conventional laparoscopy and multifactorial analysis of the learning curve for robotic surgery. Int J Colorectal Dis 29 : 555-562, 2014 https://doi.org/10.1007/s00384-014-1841-y
  19. Laudato PA, Pierzchala K, Schizas C : Pedicle screw insertion accuracy using O-arm, robotic guidance, or freehand technique: a comparative study. Spine (Phila Pa 1976) 43 : E373-E378, 2018 https://doi.org/10.1097/BRS.0000000000002449
  20. Li HM, Zhang RJ, Shen CL : Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials: a meta-analysis. Spine (Phila Pa 1976) 45 : E111-E119, 2020 https://doi.org/10.1097/BRS.0000000000003193
  21. Lieberman IH, Kisinde S, Hesselbacher S : Robotic-assisted pedicle screw placement during spine surgery. JBJS Essent Surg Tech 10 : e0020, 2020 https://doi.org/10.2106/JBJS.ST.19.00020
  22. Lien SB, Liou NH, Wu SS : Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J 16 : 1215-1222, 2007 https://doi.org/10.1007/s00586-006-0245-2
  23. Lopez IB, Benzakour A, Mavrogenis A, Benzakour T, Ahmad A, Lemee JM : Robotics in spine surgery: systematic review of literature. Int Orthop 47 : 447-456, 2023 https://doi.org/10.1007/s00264-022-05508-9
  24. Lynn G, Mukherjee DP, Kruse RN, Sadasivan KK, Albright JA : Mechanical stability of thoracolumbar pedicle screw fixation: the effect of crosslinks. Spine 25 : 31S-35S, 2000 https://doi.org/10.1097/00007632-200003151-00005
  25. Mahomed S : Healthcare, artificial intelligence and the Fourth Industrial Revolution: ethical, social and legal considerations. S Afr J Bioeth Law 11 : 93-95, 2018 https://doi.org/10.7196/SAJBL.2018.v11i2.664
  26. Peng YN, Tsai LC, Hsu HC, Kao CH : Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials. Ann Transl Med 8 : 824, 2020 https://doi.org/10.21037/atm-20-1106
  27. Pennington Z, Judy BF, Zakaria HM, Lakomkin N, Mikula AL, Elder BD, et al. : Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula. Neurosurg Focus 52 : E3, 2022
  28. Ringel F, Stuer C, Reinke A, Preuss A, Behr M, Auer F, et al. : Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: a prospective randomized comparison to conventional freehand screw implantation. Spine (Phila Pa 1976) 37 : E496-E501, 2012 https://doi.org/10.1097/BRS.0b013e31824b7767
  29. Schatlo B, Martinez R, Alaid A, von Eckardstein K, Akhavan-Sigari R, Hahn A, et al. : Unskilled unawareness and the learning curve in robotic spine surgery. Acta Neurochir (Wien) 157 : 1819-1823; discussion 1823, 2015 https://doi.org/10.1007/s00701-015-2535-0
  30. Shin MH, Ryu KS, Park CK : Accuracy and safety in pedicle screw placement in the thoracic and lumbar spines : comparison study between conventional C-arm fluoroscopy and navigation coupled with O-arm® guided methods. J Korean Neurosurg Soc 52 : 204-209, 2012 https://doi.org/10.3340/jkns.2012.52.3.204
  31. Siddiqui MI, Wallace DJ, Salazar LM, Vardiman AB : Robot-assisted pedicle screw placement: learning curve experience. World Neurosurg 130 : e417-e422, 2019 https://doi.org/10.1016/j.wneu.2019.06.107
  32. Tiwari A, Pandey S, Naik DC : A study of height and width of typical lumbar pedicles in relation to mechanical load. Int J Med Sci Public Health 4 : 275, 2015 https://doi.org/10.5455/ijmsph.2015.0410201450
  33. Toossi N, Vardiman AB, Benech CA, Kanaly CW, Maltenfort MG, Backes DM, et al. : Factors affecting the accuracy of pedicle screw placement in robot-assisted surgery: a multicenter study. Spine (Phila Pa 1976) 47 : 1613-1619, 2022 https://doi.org/10.1097/BRS.0000000000004473
  34. Vardiman AB, Wallace DJ, Crawford NR, Riggleman JR, Ahrendtsen LA, Ledonio CG : Pedicle screw accuracy in clinical utilization of minimally invasive navigated robot-assisted spine surgery. J Robot Surg 14 : 409- 413, 2020 https://doi.org/10.1007/s11701-019-00994-3
  35. Vo CD, Jiang B, Azad TD, Crawford NR, Bydon A, Theodore N : Robotic spine surgery: current state in minimally invasive surgery. Global Spine J 10(2 Suppl) : 34S-40S, 2020 https://doi.org/10.1177/2192568219878131
  36. Yi M, Song J, Zhang Y, Lin W, Yao M, Fan Y, et al. : Risk factor analysis of the accuracy and safety of planned and actual screw paths with robot-assisted technology. Available at : https://doi. org/10.21203/rs.3.rs-2220116/v1
  37. Zhang JN, Fan Y, Hao DJ : Risk factors for robot-assisted spinal pedicle screw malposition. Sci Rep 9 : 3025, 2019 https://doi.org/10.1038/s41598-019-40057-z
  38. Zhang Q, Fan MX, Han XG, Liu YJ, He D, Liu B, et al. : Risk factors of unsatisfactory robot-assisted pedicle screw placement: a case-control study. Neurospine 18 : 839-844, 2021  https://doi.org/10.14245/ns.2142560.180