Abstract：
BACKGROUND: Robotic spine surgery, utilizing 3D imaging and robotic arms, has been shown to improve the accuracy of pedicle screw placement compared to conventional methods, although its superiority remains under debate. There are few studies evaluating the accuracy of 3D navigated versus robotic-guided screw placement across lumbar levels, addressing anatomical challenges to refine surgical strategies and patient safety.
OBJECTIVE: This study aims to investigate the pedicle screw placement accuracy between 3D navigation and robotic arm-guided systems across distinct lumbar levels.
METHODS: A retrospective review of a prospectively collected registry PATIENT SAMPLE: Patients undergoing fusion surgery with pedicle screw placement in the prone position, using either via 3D image navigation only or robotic arm guidance OUTCOME MEASURE: Radiographical screw accuracy was assessed by the postoperative computed tomography (CT) according to the Gertzbein-Robbins classification, particularly focused on accuracy at different lumbar levels.
METHODS: Accuracy of screw placement in the 3D navigation (Nav group) and robotic arm guidance (Robo group) was compared using Chi-squared test/Fisher\'s exact test with effect size measured by Cramer\'s V, both overall and at each specific lumbosacral spinal level.
RESULTS: A total of 321 patients were included (Nav, 157; Robo, 189) and evaluated 1210 screws (Nav, 651; Robo 559). The Robo group demonstrated significantly higher overall accuracy (98.6 vs. 93.9%; p<.001, V=0.25). This difference of no breach screw rate was signified the most at the L3 level (No breach screw: Robo 91.3 vs. 57.8%, p<.001, V=0.35) followed by L4 (89.6 vs. 64.7%, p<.001, V=0.28), and L5 (92.0 vs. 74.5%, p<.001, V=0.22). However, screw accuracy at S1 was not significant between the groups (81.1 vs. 72.0%, V=0.10).
CONCLUSIONS: This study highlights the enhanced accuracy of robotic arm-guided systems compared to 3D navigation for pedicle screw placement in lumbar fusion surgeries, especially at the L3, L4, and L5 levels. However, at the S1 level, both systems exhibit similar effectiveness, underscoring the importance of understanding each system\'s specific advantages for optimization of surgical complications.
OBJECTIVE: This study aims to investigate the pedicle screw placement accuracy between 3D navigation and robotic arm-guided systems across distinct lumbar levels.
METHODS: A retrospective review of a prospectively collected registry PATIENT SAMPLE: Patients undergoing fusion surgery with pedicle screw placement in the prone position, using either via 3D image navigation only or robotic arm guidance OUTCOME MEASURE: Radiographical screw accuracy was assessed by the postoperative computed tomography (CT) according to the Gertzbein-Robbins classification, particularly focused on accuracy at different lumbar levels.
METHODS: Accuracy of screw placement in the 3D navigation (Nav group) and robotic arm guidance (Robo group) was compared using Chi-squared test/Fisher\'s exact test with effect size measured by Cramer\'s V, both overall and at each specific lumbosacral spinal level.
RESULTS: A total of 321 patients were included (Nav, 157; Robo, 189) and evaluated 1210 screws (Nav, 651; Robo 559). The Robo group demonstrated significantly higher overall accuracy (98.6 vs. 93.9%; p<.001, V=0.25). This difference of no breach screw rate was signified the most at the L3 level (No breach screw: Robo 91.3 vs. 57.8%, p<.001, V=0.35) followed by L4 (89.6 vs. 64.7%, p<.001, V=0.28), and L5 (92.0 vs. 74.5%, p<.001, V=0.22). However, screw accuracy at S1 was not significant between the groups (81.1 vs. 72.0%, V=0.10).
CONCLUSIONS: This study highlights the enhanced accuracy of robotic arm-guided systems compared to 3D navigation for pedicle screw placement in lumbar fusion surgeries, especially at the L3, L4, and L5 levels. However, at the S1 level, both systems exhibit similar effectiveness, underscoring the importance of understanding each system\'s specific advantages for optimization of surgical complications.
摘要：
背景：机器人脊柱手术，利用3D成像和机器人手臂，与传统方法相比，已被证明可以提高椎弓根螺钉放置的准确性，尽管它的优越性仍在争论中。很少有研究评估3D导航与机器人引导螺钉在腰椎水平上放置的准确性，解决解剖学挑战，以完善手术策略和患者安全。
目的：本研究旨在研究跨不同腰椎水平的3D导航和机械臂引导系统之间的椎弓根螺钉放置精度。
方法：回顾性回顾前瞻性收集的登记患者样本：俯卧位椎弓根螺钉融合手术的患者，仅使用3D图像导航或机械臂引导结果测量：根据Gertzbein-Robbins分类，通过术后计算机断层扫描（CT）评估放射学螺钉的准确性，特别是集中在不同的腰椎水平的准确性。
方法：使用卡方检验/Fisher精确检验比较了3D导航（Nav组）和机械臂引导（Robo组）中螺钉放置的准确性，并通过Cramer的V，整体和每个特定的腰骶椎水平。
结果：共纳入321例患者（Nav，157；罗博，189）和评估的1210螺钉（Nav，651；Robo559）。Robo组表现出明显更高的整体准确性（98.6vs.93.9%；P<0.001，V=0.25）。在L3级别，没有违反螺钉率的差异最大(没有违反螺钉：Robo91.3与57.8%,P<0.001，V=0.35），其次是L4（89.6vs.64.7%,P<0.001，V=0.28），和L5（92.0与74.5%,P<0.001,V=0.22)。然而,S1处的螺钉精度在组间无显著差异(81.1vs.72.0%,V=0.10)。
结论：这项研究强调了与3D导航相比，机器人手臂引导系统在腰椎融合手术中椎弓根螺钉置入的准确性提高，尤其是在L3、L4和L5级别。然而,在S1级，这两个系统表现出相似的有效性，强调了解每个系统对优化手术并发症的具体优势的重要性。
目的：本研究旨在研究跨不同腰椎水平的3D导航和机械臂引导系统之间的椎弓根螺钉放置精度。
方法：回顾性回顾前瞻性收集的登记患者样本：俯卧位椎弓根螺钉融合手术的患者，仅使用3D图像导航或机械臂引导结果测量：根据Gertzbein-Robbins分类，通过术后计算机断层扫描（CT）评估放射学螺钉的准确性，特别是集中在不同的腰椎水平的准确性。
方法：使用卡方检验/Fisher精确检验比较了3D导航（Nav组）和机械臂引导（Robo组）中螺钉放置的准确性，并通过Cramer的V，整体和每个特定的腰骶椎水平。
结果：共纳入321例患者（Nav，157；罗博，189）和评估的1210螺钉（Nav，651；Robo559）。Robo组表现出明显更高的整体准确性（98.6vs.93.9%；P<0.001，V=0.25）。在L3级别，没有违反螺钉率的差异最大(没有违反螺钉：Robo91.3与57.8%,P<0.001，V=0.35），其次是L4（89.6vs.64.7%,P<0.001，V=0.28），和L5（92.0与74.5%,P<0.001,V=0.22)。然而,S1处的螺钉精度在组间无显著差异(81.1vs.72.0%,V=0.10)。
结论：这项研究强调了与3D导航相比，机器人手臂引导系统在腰椎融合手术中椎弓根螺钉置入的准确性提高，尤其是在L3、L4和L5级别。然而,在S1级，这两个系统表现出相似的有效性，强调了解每个系统对优化手术并发症的具体优势的重要性。
