Abstract
Introduction
The Renaissance Robotic System is a technology used to guide screw placement through thoracic and lumbar spinal pedicle with high accuracy. This research introduces evaluation of the first series of 93 patients used this system in Vietnam for further evaluating the accuracy of the robotic guidance system for spinal surgery.
Material and Methods
Patients underwent spinal surgery using pedicle screws placement are main subjects of this research. Total 93 patients were divided into 2 groups (MIS group and classic procedure group). Among each group, the first 10 cases were studied and compared with the remaining cases. The accuracy of 1003 pedicle screws inserted in 93 patients was measured via postoperative CT scans system. The result based on the position of screw was evaluated in 3 aspects: axial, lateral and A-P.
Results
93 patients under this research include 6 patients of trauma case, 29 patients of scoliosis case, 58 patients of spondylolisthesis case. Measurements derived from postoperative CT scans demonstrated the fact that 98.3% of the screws fell within the safe zone (Group A and B), where 90.3% were completely within the pedicle (Gertbein and Robbins classification). The MIS procedure was performed on 33 patients. Among these 33 patients, there appeared a significantly different accuracy between the first ten patients to the remaining of each group (accuracy change from 80% of Group A to 95.7% of Group B, p = 0.05). Among patients group underwent the classic procedure, the accuracy between the first ten patients to the remaining of the group also showed significant difference (accuracy changed from 96.5% of Group A to 99.3% of Group B, p = 0.05). 7/1003 pedicle screws were reinserted by free hand technique. On axial aspect, 915 (91.2%) screws were totally inserted inside one half of vertebrae and did not pass the middle line. On lateral view, 883 pedicle screws (88%) were inserted at medial position of vertebrae. No neurological deficit was recorded. Average time spent for each screw is 4 minutes.
Conclusion
The Robotic Guidance enhances performance in spinal surgery by increasing the accuracy for pedicle screws placement and reducing neurologic risks. In addition, 33 cases used a percutaneous approach reported herein remark great contributions of Robotic Guidance in procedures without anatomic landmarks.