Journal of Shandong University (Health Sciences) ›› 2023, Vol. 61 ›› Issue (3): 97-106.doi: 10.6040/j.issn.1671-7554.0.2022.1113

• 临床医学 • Previous Articles    

Comparison of robot-assisted minimally invasive and freehand open transforaminal lumbar interbody fusion for degenerative lumbar spinal diseases: a 2-year follow-up

WANG Zheng1, SUN Xiaogang2, LI Chao1, WANG Lianlei1, LI Donglai1, YUAN Suomao1, TIAN Yonghao1, LIU Xinyu1   

  1. 1. Department of Spinal Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China;
    2. Department of Spinal Surgery, Tengzhou Central Peoples Hospital, Tengzhou 277500, Shandong, China
  • Published:2023-03-24

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Abstract: Objective To prospectively compare the clinical and radiographic outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and freehand open transforaminal lumbar interbody fusion(TLIF)in patients with degenerative lumbar spinal diseases. Methods A total of 127 patients with lumbar degenerative diseases receiving surgery in Qilu Hospital of Shandong University were enrolled, including 73 who underwent robot-assisted MIS-TLIF(group A)and 54 who underwent open TLIF(group B). Group A was subdivided into subgroup AI(52 single-level patients)and subgroup AII(21 double-level patients). Group B was subdivided into subgroup BI(39 single-level patients)and subgroup BII(15 double-level patients). The clinical outcome parameters were compared, including the Visual Analog Scale(VAS)score, Oswestry Disability Index(ODI)score, operation time, number of intraoperative fluoroscopies, intraoperative blood loss, postoperative hospital stay, and postoperative complications. The radiographic measures included the accuracy of screw placement, facet joint violation(FJV), fusion status, and change in disc height at the proximal adjacent segment at 2-year follow-up. Results Group A had lower VAS score for back pain at 3 days postoperatively, and less blood loss than group B(P<0.05). There were no significant differences between the two groups in terms of postoperative hospital stay, VAS score and ODI score at 2 years postoperatively(P>0.05). Group A needed longer operation time than group B(P<0.05), subgroup AI needed longer operation time than subgroup BI(P<0.05); however, there was no significant difference between subgroups AII and BII(P>0.05). The number of intraoperative fluoroscopies for patients was significantly higher in group A than in group B(P<0.05), while it was significantly lower in group A than in group B for surgeons(P<0.05). In Group A, three guide pins exhibited drift and one patient developed a lateral wall violation by a pedicle screw. In Group B, two pedicle screws caused an inner wall violation. The rate of clinically acceptable screws(grades A and B)was higher in group A than in group B(P<0.05). The FJV grade was significantly higher in group B than in group A(P<0.05). During the 2-year follow-up, there was no significant difference in classification of interbody fusion between the two groups(P>0.05), but the decrease in disc height at the proximal adjacent segment was significantly less in group A than in group B (P<0.05). Conclusion Robot-assisted percutaneous pedicle screw placement is a safer and more accurate alternative to conventional freehand open pedicle screw insertion in TLIF.

Key words: Degenerative lumbar spinal diseases, Robotic surgery, Pedicle screw, Lumbar fusion, Facet joint violation, Adjacent segment disease

CLC Number: 

  • R681.5+7
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