Aim:The purpose of this study was to assess the learning curve and the accuracy of robot-assisted pedicle screw placement in the first 41 cases.Methods: This retrospective study investigated the first 41 patients undergoing spinal fusion, whereby 250 pedicle screws were inserted with robotic assistance in a private hospital by a single surgeon. The pedicle screw accuracy was evaluated by computed tomography scan by an orthopedic surgeon according to the Gertzbein and Robbins classification. Planning time and screw placement time were noted. In addition, data about any screw malposition, a return to the operating theatre, and intraoperative repositioning were collected. The data were analyzed with Microsoft Excel. Results:The results show a high degree of accuracy (98%) of pedicle screw placement with a minimally invasive robot-assisted spinal fusion with no screw malposition requiring a return to the operating theatre. The learning curve improved with time, reaching a plateau at around 25 cases. Conclusion:This study shows a high degree of accuracy of pedicle screw placement with the robot and it shows a surgeon's improved experience with the robot with time. Further comparative studies are needed to better assess the robot's accuracy and its future in spine surgery.
This study adopted a retrospective study design. Purpose: This study was designed to describe the fusion rate and technique and patient subjective improvement after sacroiliac (SI) joint fusion using a minimally invasive surgical (MIS) approach. Overview of Literature: The SI joint can mimic radicular or discogenic pain localized to the lower back, gluteal region, or sacral region, posing a challenge in the diagnosis and treatment. This study determines the radiological fusion rate and patient reported subjective clinical outcomes of SI joint fusion using an MIS approach, comparing the use of the Rialto SI joint fusion system (Medtronic, Minneapolis, MN, USA) with the help of the Stealth Navigation System with the use of ExcelsiusGPS Robotic Navigation Platform (Globus Medical Inc., Audubon, PA, USA) using SI-LOK screws (Globus Medical Inc.). Methods: In this retrospective study, 43 consecutive patients who underwent SI joint fusion between August 2017 and February 2020 were enrolled; 60 SI joints were fused. The patients' fusion was documented on computed tomography or X-rays, and Visual Analog Scale (VAS) scores were used to determine patient subjective clinical outcomes. Results: A total of 60 joints were fused, including 26 joints fused using robotic guidance and 34 joints fused using the Stealth Navigation System. Student t-test was used to compare the mean preoperative VAS score (7.52±1.3) with the mean postoperative VAS score at the 12-month follow-up (1.43±1.22) (p<0.05). The SI joint fusion rate using this technique was 61% at 6 months, 96.4% at 12 months, and 100% at 18 months. Conclusions: The use of navigation guidance or robotic assistance enables accurate percutaneous screw placement across the SI joint. The use of bone morphogenetic protein in the screw bore hastens fusion across the joint, improving patient-perceived pain.
Osteonecrosis of the femoral head is not a specific diagnostic entity, but rather the final common pathway of a series of derangements that produce a decrease in blood flow, leading to cellular death within the femoral head. It can present with a number of clinical manifestations. The most common complaint is a deep, intermittent, throbbing pain in the groin region which has an insidious onset. In the early stages, prophylactic measures are used to prevent further progression of the disease. When the patient is diagnosed in later stages, the collapse and distortion of the femoral head can be seen, for which a reconstructive procedure is the treatment of choice. The goals of total hip arthroplasty are to relieve pain, to provide motion with stability and to correct deformity so that they are able to return to their normal daily activities. Total hip arthroplasty can be the first treatment of choice. especially in the advanced stages of hip osteonecrosis, or can be reserved as a salvaging procedure when other more conservative treatments fail. Total Hip Arthroplasty is a good modality of treatment for patients with very poor pre-surgical functional scores combined with an excellent long term survival of the cement-less implants.
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