目的:脊柱转移会显著影响癌症患者的生活质量,并给外科医生带来复杂的神经外科挑战。通常需要使用器械进行手术以减轻疼痛,保护神经功能,并确保机械稳定性。然而,由于肿瘤疾病引起的骨解剖结构变形会降低椎弓根螺钉放置的准确性。与传统技术相比,机器人辅助手术可以提供增加螺钉准确性和改善脊柱病变导航的机会。因此,我们介绍了评估机器人辅助手术固定治疗脊柱转移瘤的机构经验.
方法:确定了2019年1月至2023年1月在大型三级护理中心接受机器人辅助手术治疗脊柱转移瘤的患者。患者特征,包括人口统计,肿瘤病理学,手术并发症,并提取术后结果。GertzbeinRobbins分类系统(GRS)用于评估术后计算机断层扫描患者的椎弓根螺钉放置准确性。
结果:确定了20例患者,包括7名女性(35%),总体年龄中位数为66岁(范围:39-80岁),BMI中位数为25kg/m2(范围:17-34kg/m2)。平均有四个脊柱水平,转移主要位于胸部(n=17,85%)脊柱。常见的原发肿瘤类型包括前列腺(n=4),肺(n=2),和浆细胞(n=2)癌症。大多数椎弓根螺钉(92%)在术后成像患者中被归类为GRSA。术后并发症与使用机器人无关,并包括肺栓塞(n=1),深静脉血栓形成(n=2),胃症状(n=3)。3名患者在30天再次入院,因肿瘤复发而再次手术。4名患者在手术后6个月内死亡。
结论:尽管这些手术固有的高风险,这项研究强调了机器人辅助手术治疗脊柱转移瘤的安全性和有效性.机器人有助于确保转移性疾病患者椎弓根螺钉放置的准确性。
OBJECTIVE: Spinal metastases can significantly affect quality of life in patients with cancer and present complex neurosurgical challenges for surgeons. Surgery with instrumentation is often indicated to alleviate pain, preserve neurological function, and ensure mechanical stability. However, distortions in the bony anatomy due to oncological disease can decrease the accuracy of pedicle screw placement. Robotic-assisted surgery may offer an opportunity to increase screw accuracy and improve navigation of spinal lesions compared to conventional techniques. Therefore, we presented our institutional experience evaluating robotic-assisted surgical fixation for spinal metastases.
METHODS: Patients undergoing robotic-assisted surgery at a large tertiary care center between January 2019 - January 2023 for the treatment of spinal metastases were identified. Patient characteristics, including demographics, tumor pathology, surgical complications, and post-operative outcomes were extracted. The Gertzbein Robbins classification system (GRS) was used to assess pedicle screw placement accuracy in patients with post-operative computed tomography.
RESULTS: Twenty patients were identified, including 7 females (35 %), with an overall median age of 66 years (range: 39-80 years) and median BMI of 25 kg/m2 (range: 17-34 kg/m2). An average of four spinal levels were instrumented, with metastases located primarily in the thoracic (n=17, 85 %) spine. Common primary tumor types included prostate (n=4), lung (n=2), and plasma cell (n=2) cancers. Most pedicle screws (92 %) were classified as GRS A in patients with postoperative imaging. Post-operative complications were unrelated to the use of the robot, and included pulmonary embolism (n=1), deep vein thrombosis (n=2), and gastric symptoms (n=3). Three patients were readmitted at 30 days, with one reoperation due to tumor recurrence. Four patients were deceased within 6 months of surgery.
CONCLUSIONS: Despite the inherent high-risk nature of these surgeries, this study underscores the safety and efficacy of robotic-assisted surgery in the management of spinal metastases. Robots can be helpful in ensuring accuracy of pedicle screw placement in patients with metastatic disease.