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Li Y, Wang Y, Ma X, Ma J, Dong B, Yang P, Sun Y, Zhou L, Shen J. Comparison of short-term clinical outcomes between robot-assisted and freehand pedicle screw placement in spine surgery: a meta-analysis and systematic review. J Orthop Surg Res 2023; 18:359. [PMID: 37189203 DOI: 10.1186/s13018-023-03774-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/01/2023] [Indexed: 05/17/2023] Open
Abstract
STUDY DESIGN Meta-analysis and systematic review. BACKGROUND Robot-assisted pedicle screw placement technique offers greater accuracy than the traditional freehand screw placement technique. However, it is controversial whether there is a difference between the two procedures in terms of improved clinical outcomes. MATERIALS AND METHODS We systematically searched PubMed, EMBASE, Cochrane, and Web of Science to identify potentially eligible articles. Indispensable data such as the year of publication, study type, age, number of patients, sex distribution, and outcomes were extracted. The outcome indicators of interest included Oswestry disability index (ODI), visual analog scale (VAS) score, operative time, intraoperative blood loss, and post-operative length of stay. RevMan 5.4.1 was used for the meta-analysis. RESULTS A total of eight studies with 508 participants were included. Eight were related to ΔVAS, six were related to ΔODI, seven were related to operative time, five were related to intraoperative blood loss, and seven were related to the length of hospitalization. The results showed that, in terms of ΔVAS (95% CI, -1.20 to -0.36, P = 0.0003) and ΔODI (95% CI, -2.50 to -0.48, P = 0.004), robot-assisted pedicle screw placement technique scored higher than traditional freehand technique. Additionally, the intraoperative blood loss (95% CI, -140.34 to -10.94, P = 0.02) and the length of hospitalization (95% CI, -2.59 to -0.31, P = 0.01) for patients who underwent robotic-assisted pedicle screw placement were less than that of those who underwent the conventional freehand screw placement. No significant difference was found between robot-assisted techniques and conventional freehand techniques in pedicle screw placement in surgical time (95% CI, -2.24 to 26.32, P = 0.10). CONCLUSIONS Robot-assisted technique helps improve short-term clinical outcomes, reduce intraoperative blood loss and patient suffering, and shorten recovery time compared to the freehand technique.
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Affiliation(s)
- Yiyang Li
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Yan Wang
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Xinlong Ma
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China.
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China.
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China.
| | - Jianxiong Ma
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China.
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China.
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China.
| | - Benchao Dong
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Peichuan Yang
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Yadi Sun
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Liyun Zhou
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Jiahui Shen
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
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Benzakour A, Altsitzioglou P, Lemée JM, Ahmad A, Mavrogenis AF, Benzakour T. Artificial intelligence in spine surgery. INTERNATIONAL ORTHOPAEDICS 2023; 47:457-465. [PMID: 35902390 DOI: 10.1007/s00264-022-05517-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 01/28/2023]
Abstract
The continuous progress of research and clinical trials has offered a wide variety of information concerning the spine and the treatment of the different spinal pathologies that may occur. Planning the best therapy for each patient could be a very difficult and challenging task as it often requires thorough processing of the patient's history and individual characteristics by the clinician. Clinicians and researchers also face problems when it comes to data availability due to patients' personal information protection policies. Artificial intelligence refers to the reproduction of human intelligence via special programs and computers that are trained in a way that simulates human cognitive functions. Artificial intelligence implementations to daily clinical practice such as surgical robots that facilitate spine surgery and reduce radiation dosage to medical staff, special algorithms that can predict the possible outcomes of conservative versus surgical treatment in patients with low back pain and disk herniations, and systems that create artificial populations with great resemblance and similar characteristics to real patients are considered to be a novel breakthrough in modern medicine. To enhance the body of the related literature and inform the readers on the clinical applications of artificial intelligence, we performed this review to discuss the contribution of artificial intelligence in spine surgery and pathology.
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Affiliation(s)
- Ahmed Benzakour
- Centre Orléanais du Dos - Pôle Santé Oréliance, Saran, France
| | - Pavlos Altsitzioglou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Jean Michel Lemée
- Department of Neurosurgery, University Hospital of Angers, Angers, France
| | | | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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Fan M, Fang Y, Zhang Q, Zhao J, Liu B, Tian W. A prospective cohort study of the accuracy and safety of robot-assisted minimally invasive spinal surgery. BMC Surg 2022; 22:47. [PMID: 35148734 PMCID: PMC8832639 DOI: 10.1186/s12893-022-01503-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/31/2022] [Indexed: 01/02/2023] Open
Abstract
Background Robot-assisted open surgery (RA-OS) is now commonly used in traditional open-exposure spinal screw placement surgery. With the help of robots, robot-assisted minimally invasive surgery (RA-MIS) can achieve less bleeding and less tissue damage in percutaneous screw insertion. While the research comparing the safety and accuracy of screw placement between RA-MIS and RA-OS is insufficient. This study aims to compare the effects of RA-MIS and RA-OS in thoracic and lumbar spine. Methods This was a prospective cohort study evaluating 208 patients undergoing robot-assisted screw insertions from July 2020 to September 2021. Age, BMI, gender, screws accuracy, screws Gertzbein–Robbins grade, small joint invasion and perioperative outcomes (operation time, blood loss, postoperative hospital stay, comorbidity) were collected. A subgroup analysis was also performed according to disease, namely fracture, spondylolisthesis, and disc herniation. Data were analyzed using Stata/MP 14.0. Wilcoxon’s signed rank test, Kruskal–Wallis test and Fisher’s exact test were used for statistical tests and p < 0.05 was considered statistically significant. Results A total of 1030 screws were inserted; 368 minimally invasive screws and 662 open screws. The acceptability of screw insertion in the RA-MIS and RA-OS was 97.3% and 95.6% respectively. There was no statistical difference between the RA-MIS group and RA-OS group in age (p = 0.106), gender (p = 0.074), BMI (p = 0.181) and comorbidity (p = 0.203). Compared with RA-OS, RA-MIS had less blood loss (p < 0.001) and shorter postoperative hospital stay (p = 0.008). In the minimally invasive surgery group, the fracture subgroup had smaller screw deviation, less blood loss, and shorter operation time compared with the other subgroups (p < 0.01). Specifically, RA-MIS significantly reduced the postoperative hospital stay of patients with spondylolisthesis compared with RA-OS (p < 0.01). Conclusion RA-OS and RA-MIS had equal accuracy and safety. Compared with open surgery, minimally invasive surgery reduced blood loss in each subgroup and shortened the postoperative hospital stay in the spondylolisthesis subgroup. Compared with the other subgroups under minimally invasive surgery, the fracture subgroup had less blood loss and shorter operation time. Clinical trial registration: NCT04040868. Registered 1 March 2019, https://clinicaltrials.gov/ct2/show/NCT04040868?cond=Accuracy+Study+of+Robot-assisted+Screw+Insertion+in+Spinal+Surgery&draw=2&rank=1.
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Affiliation(s)
- Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yanming Fang
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Qi Zhang
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Jingwei Zhao
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Bo Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Beijing, China. .,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China.
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Tu P, Yan CC, Hao JX, Cao S, Jiang C. Effect of percutaneous minimally invasive pedicle screw internal fixation in the treatment of thoracolumbar vertebral fractures and its impact on quality of life. Pak J Med Sci 2022; 38:100-105. [PMID: 35035408 PMCID: PMC8713235 DOI: 10.12669/pjms.38.1.4329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/28/2021] [Accepted: 08/08/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To investigate and analyze the effect of percutaneous minimally invasive pedicle screw internal fixation in the treatment of thoracolumbar vertebral fractures and its impact on quality of life. Methods Fifty patients with thoracolumbar vertebral fracture admitted to our hospital from January 2015 to December 2018 were selected and divided into two groups according to different treatment regimens. The observation group was treated with minimally invasive percutaneous pedicle screw internal fixation, while the control group was treated with traditional posterior approach open pedicle screw internal fixation. The surgery time, incision length, intraoperative blood loss, postoperative drainage, hospitalization time, ambulation time, fracture healing time and postoperative VAS scores were compared between the two groups. In addition, the cobb angle, the sagittal plane index, and the anterior vertebral height were compared between the two groups before and after surgery, as were the Oswestry Disability Index (ODI) at 1d, 3 months, and 6 months postoperatively. Results The surgery time, incision length, postoperative pain level, postoperative drainage and intraoperative blood loss of the observation group were less than those of the control group (P<0.05). The postoperative Cobb angle of the two groups decreased, the sagittal plane index as well as the anterior vertebral height increased (P<0.05). The Oswestry index of the observation group was better than that of the control group at one day and three months postoperatively, with a statistical significance between the two groups (P<0.05). The complication rate of the observation group was significantly lower than that of the control group (P<0.05). Conclusion Percutaneous minimally invasive pedicle screw internal fixation is safer than the traditional open pedicle screw internal fixation, and it is more worthy of clinical promotion.
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Affiliation(s)
- Pengfa Tu
- Pengfa Tu, Department of Orthopaedics, Baoding No.1 Hospital, Baoding, Hebei, 071000, P.R. China
| | - Chong-Chao Yan
- Chong-chao Yan, Department of Orthopaedics, Baoding No.1 Hospital, Baoding, Hebei, 071000, P.R. China
| | - Jian-Xue Hao
- Jian-xue Hao, Department of Orthopaedics, Baoding No.1 Hospital, Baoding, Hebei, 071000, P.R. China
| | - Shuo Cao
- Shuo Cao, Department of Orthopaedics, Baoding First Central Hospital, Baoding, Hebei, 071000, P.R. China
| | - Chenyang Jiang
- Chenyang Jiang, Department of Orthopaedics, Baoding No.1 Hospital, Baoding, Hebei, 071000, P.R. China
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Luo J, Yan YJ, Wang XD, Long XD, Lan H, Li KN. Accuracy and Safety of Robot-Assisted Drilling Decompression for Osteonecrosis of the Femoral Head. Orthop Surg 2020; 12:784-791. [PMID: 32394643 PMCID: PMC7307221 DOI: 10.1111/os.12678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/14/2020] [Accepted: 03/18/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To investigate the safety and superiority of robot-assisted femoral head drilling decompression in the treatment of femoral head necrosis. METHODS A total of 63 patients who underwent borehole decompression of the femoral head in our hospital from January 2016 to March 2019 were recruited. Patients were divided into two groups for comparison according to surgical methods. In the robot-assisted surgery group, there were 30 cases with 41 femoral heads. The conventional group had 33 cases and 46 femoral heads. All patients signed the consent form before the operation. The follow-up time was 6 months. The incision lengths, operation times, intraoperative blood loss, intraoperative fluoroscopies, guide needle punctures, postoperative Harris scores, and postoperative complications of the two groups were compared. RESULTS The incision length of the robot surgery group was 5.16 ± 0.41 cm, while that of the traditional surgery group was 7.42 ± 0.50 cm. The operation time of the robot surgery group was 46.99 ± 4.94 min, while that of the traditional surgery group was 55.01 ± 6.19 min. The fluoroscopy frequency of the robot surgery group was 10.50 ± 1.78 times, while that of the traditional surgery group was 17.91 ± 2.20 times. The intraoperative blood loss in the robotic surgery group was 20.62 ± 2.52 mL, while that in the conventional surgery group was 52.72 ± 3.39 mL. In the robot operation group, each femoral head guide needle was punctured three times, and the puncture was successful one time. The number of guided needle punctures in the traditional group was 8.02 ± 1.73. The difference between the two groups was statistically significant (P < 0.05). The Harris score was 69.53 ± 7.51 in the robot surgery group and 68.38 ± 7.26 in the traditional surgery group one month after surgery, 78.52 ± 6.49 in the robot surgery group and 76.41 ± 7.95 in the traditional surgery group three months after surgery, and 83.32 ± 8.62 in the robot surgery group and 81.74 ± 6.20 in the traditional surgery group six months after surgery. There was no significant difference between the two groups (P > 0.05). In the traditional group, there was one case of incision infection and one case of femoral head collapse during follow-up. In the robot group, there were no complications, such as incision infection and deep vein thrombosis. No collapse of the femoral head was found in the robot group during follow-up. CONCLUSION The positioning system of the orthopaedic robot is an ideal method for the treatment of femoral head necrosis. This method has the advantages of simple operation, accurate drilling, a short operation time, less surgical trauma, less radioactivity, and good recovery of hip joint function.
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Affiliation(s)
- Jin Luo
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Ya-Jing Yan
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Xiao-Dong Wang
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Xu-Dong Long
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Hai Lan
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Kai-Nan Li
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
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