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首页> 外文期刊>Neurosurgical focus >Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis
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Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

机译：机器人引导的腰椎融合治疗腰椎滑脱术后螺钉位置不正确和临床结果的修订

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OBJECTIVE The accuracy of robot-guided pedicle screw placement has been proven to be high, but little is known about the impact of such guidance on clinical outcomes such as the rate of revision surgeries for screw malposition. In addition, there are very few data about the impact of robot-guided fusion on patient-reported outcomes (PROs). Thus, the clinical benefit for the patient is unclear. In this study, the authors analyzed revision rates for screw malposition and changes in PROs following minimally invasive robot-guided pedicle screw fixation. METHODS A retrospective cohort study of patients who had undergone minimally invasive posterior lumbar interbody fusion (MI-PLIF) or minimally invasive transforaminal lumbar interbody fusion was performed. Patients were followed up clinically at 6 weeks, 12 months, and 24 months after treatment and by mailed questionnaire in March 2016 as a final follow-up. Visual analog scale (VAS) scores for back and leg pain severity, Oswestry Disability Index (ODI), screw revisions, and socio-demographic factors were analyzed. A literature review was performed, comparing the incidence of intraoperative screw revisions and revision surgery for screw malposition in robot-guided, navigated, and freehand fusion procedures. RESULTS Seventy-two patients fit the study inclusion criteria and had a mean follow up of 32 ± 17 months. No screws had to be revised intraoperatively, and no revision surgery for screw malposition was needed. In the literature review, the authors found a higher rate of intraoperative screw revisions in the navigated pool than in the robot-guided pool (p CONCLUSIONS In adults with low-grade spondylolisthesis, the data demonstrated a benefit in using robotic guidance to reduce the rate of revision surgery for screw malposition as compared with other techniques of pedicle screw insertion described in peer-reviewed publications. Larger comparative studies are required to assess differences in PROs following a minimally invasive approach in spinal fusion surgeries compared with other techniques.
机译：目的已经证明机器人引导的椎弓根螺钉放置的准确性很高，但是对于这种指导对临床结果（例如螺钉位置不正的翻修手术率）的影响知之甚少。此外，关于机器人引导融合对患者报告结局（PRO）影响的数据很少。因此，对于患者的临床益处尚不清楚。在这项研究中，作者分析了微创机器人引导的椎弓根螺钉固定后螺钉位置不正确的修正率和PRO的变化。方法进行了一项回顾性队列研究，研究对象是经过微创后路腰椎椎间融合术（MI-PLIF）或微创经椎间孔腰椎椎体间融合术的患者。在治疗后6周，12个月和24个月对患者进行临床随访，并于2016年3月通过邮寄问卷进行最终随访。分析了背部和腿部疼痛严重程度的视觉模拟量表（VAS）评分，Oswestry残疾指数（ODI），螺丝钉修订和社会人口统计学因素。进行了文献综述，比较了机器人引导，导航和徒手融合手术中术中螺钉翻修和螺钉定位不良的翻修手术的发生率。结果72例患者符合研究纳入标准，平均随访32±17个月。术中无需螺钉固定，也不需要因螺钉位置不正确而进行的螺钉固定手术。在文献综述中，作者发现，导航池中的术中螺钉翻修率比机器人引导池中高（p结论）在低度腰椎滑脱成人中，数据显示了使用机器人指导降低率的益处。与同行评审的文献中介绍的其他椎弓根螺钉插入技术相比，修复手术治疗螺钉位置不正确与其他技术相比，需要更大的比较研究来评估采用微创方法进行的脊柱融合手术中PRO的差异。

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