背景:椎弓根螺钉侵犯小关节可能导致相邻节段疾病和术后疼痛。先前的研究已经报道了使用各种椎弓根螺钉插入技术的头骨小关节侵犯的发生率。然而,尚未确定在机器人引导下侵犯小关节的发生率。
目的:研究并比较机器人引导和计算机断层扫描(CT)导航引导下椎弓根螺钉侵犯头端小关节的发生率。
方法:回顾性匹配队列患者样本:所有直到2023年在主要脊柱中心接受机器人辅助腰椎融合术的患者均进行回顾性鉴定,并根据年龄与接受CT导航引导的患者进行1:3匹配,性别,头端椎体水平,和构造的长度。纳入标准包括年龄大于18岁,双侧椎弓根螺钉固定,以及术后任何时候腰椎或腹部/骨盆的CT扫描。
方法:头颅关节侵犯方法:使用描述性统计来比较队列:频率,分类变量的卡方分析,和连续变量的t检验。
结果:204例患者共植入408枚头端椎弓根螺钉(机器人:102;导航:306)。总的来说,在机器人队列中观察到13例(12.3%)头端小关节侵犯,在导航队列中观察到75例(24.5%)(p=0.01)。具体来说,在L2观察到较少的机器人违规(3.5%对32.1%,p=0.003)和L3水平(3.9%与18.1%,p=0.08)与导航相比。在L4和L5没有观察到差异。机器人方法显著减少了双边违规行为(5.3%与14.4%,p=0.03)。最后,在开放式进近期间观察到更多的关节侵犯(机器人:18.8%,导航:27.3%)比经皮入路(机器人:11.6%,导航:7.1%),两组(p<0.001)。L4小平面侵犯率在机器人队列中为18.8%,在导航队列中为27.3%。在机器人队列中,L5小平面违规率为31.3%,在导航队列中为29.2%。
结论:与L2和L3水平的导航引导相比,在腰椎椎弓根螺钉中使用机器人辅助显着降低了头端小关节侵犯的发生率,但在L4和L5时则没有,L5螺钉处的小平面侵犯接近近三分之一的患者。在邻近节段变性和疾病中,颅骨小平面的侵犯可以发挥重要作用。技术因素和轨迹问题可能会发挥作用,解决这些组件应尽量减少意外的方面违规和近端增加。
BACKGROUND: Facet joint violation by pedicle screws may lead to adjacent-segment disease and postoperative pain. Previous studies have reported the incidence of rostral facet joint violation using various pedicle screw insertion techniques. However, the incidence of facet joint violations with robotic guidance has not been determined.
OBJECTIVE: To investigate and compare the incidence of rostral facet joint violation by pedicle screws under robotic guidance and computerized tomography (CT) navigation guidance.
METHODS: Retrospective Matched Cohort PATIENT SAMPLE: All patients who underwent robotic-assisted lumbar fusion at a major spine center up until 2023 were retrospectively identified and matched 1:3 to patients undergoing CT
navigation guidance based by on age, sex, rostral vertebral level, and length of construct. Inclusion criteria consisted of age greater than 18 years, bilateral pedicle screw fixation, and presence of a postoperative CT scan of the lumbar spine or abdomen/pelvis at any point in the post-operative period.
METHODS: Rostral facet joint violations METHODS: Descriptive statistics were used to compare cohorts: frequencies, chi-squared analysis for categorical variables, and t-test for continuous variables.
RESULTS: A total of 408 rostral pedicle screws were implanted in 204 patients (Robot: 102; Navigation: 306). Overall, 13 (12.3%) rostral facet joint violations were observed in the robot cohort and 75 (24.5%) in the navigation cohort (p=0.01). Specifically, fewer robotic violations were observed at the L2 (3.5% vs 32.1%, p=0.003) and L3 levels (3.9% vs. 18.1%, p=0.08) compared to navigation. No difference was observed at L4 and L5. Bilateral violations are significantly reduced with robotic approaches (5.3% vs. 14.4%, p=0.03). Lastly, more facet joint violations were observed during open approaches (robot: 18.8%,
navigation: 27.3%) than percutaneous approaches (robot: 11.6%,
navigation: 7.1%) in both groups (p<0.001). The rate of L4 facet violations was 18.8% in the robotic cohort and 27.3% in the
navigation cohort. The rate of L5 facet violations was 31.3% in the robotic cohort and 29.2% in the
navigation cohort.
CONCLUSIONS: Use of robotic assistance in lumbar pedicle screws significantly reduced the rate of rostral facet joint violations compared to navigation guidance at L2 and L3 levels, but not at L4 and L5, with facet violations approaching nearly one-third of the patients at L5 screws. Rostral facet violations can play a significant role in adjacent segment degeneration and disease. Technical factors and trajectory issues likely play a role and addressing these components should minimize unintended facet violation and proximal adding on.