Robot‐Aided Minimally Invasive Lumbopelvic Fixation in Treatment of Traumatic Spinopelvic Dissociation

Abstract

Objective: To investigate the surgical strategy, safety, and efficacy of close reduction and robot-aided minimally invasive lumbopelvic fixation in treatment of traumatic spinopelvic dissociation. Methods: Data of 32 patients (21 males and 11 females) with traumatic spinopelvic dissociation treated by lumbopelvic fixation with robot-aided minimally invasive technique or conventional open procedure in our institution from March 2010 to April 2019 were retrospectively analyzed, and divided into robot group and control group. Intraoperative blood loss, surgical time, fluoroscopy frequency, total drilling times, infection rate, hospitalization time, and sacral fracture healing time were reviewed. Radiographs and computed tomography (CT) scans were totally acquired to evaluate the reduction quality, residual fracture displacement, and Gras classification on screws insertion after surgery. According to the Majeed scoring system, functional outcome was assessed for each patient at the final follow-up. Results: There were 12 patients in the robot group and 20 patients in the control group with no significant difference about the demographic data. The average surgical time was 148.3 ± 40.5 min with intraoperative blood loss of 142.5±36.7 mL in the robot group and 185.0 ± 47.8 min with 612.5 ± 182.7 mL in the control group (P = 0.034, P = 0.000). The robot group had a shorter mean hospitalization time at 19.9 ± 7.0 days compared to the control group with 28.6 ± 5.4 days (P = 0.010). The fluoroscopy frequency was 35.4 ± 3.0 in the robot group and 45.5 ± 3.6 in the control group (P = 0.000) and total drilling times were 7.1 ± 1.1 and 9.6 ± 1.3 (P = 0.000), respectively. The infection rate was 0% (0/12) in the robot group and 15% (3/20) in the control group (P = 0.159). According to the Gras classification on screw positioning, there were 11 cases in Grade I and 1 case in Grade II in the robot group, and 14 cases in Grade I and 6 cases in Grade II in the control group. All the patients were followed up consecutively for at least 12 months, with an average follow-up period of 17.1 ± 3.6 months. All sacral fractures healed with an average time of 3.8 ± 0.6 months in the robot group and 4.7 ± 0.7 months in the control group (P = 0.000). According to Majeed functional assessment investigation, the mean score of the patients was 87.2 ± 4.0 in the robot group and 83.1 ± 4.5 in the control group (P = 0.015). Conclusions: Robot-aided minimally invasive lumbopelvic fixation for traumatic spinopelvic dissociation is a safe and feasible option with advantages of less intraoperative blood loss, less radiation damage, less hospitalization time, and better functional outcome.

Comparative Study of Triangular Osteosynthesis with and without Robotic Assistance for Unilateral Unstable Sacral Fractures Involving Lumbosacral Junction Injuries

“…According to recorded frequency of intraoperative uoroscopy, the data in this study were signi cantly decreased in the robot group (P < 0.001), which was similar to the existing reports using the same technique [16,17,24]. All guide pins in the robot group were basically successfully implanted at one time, while that in the conventional group needs to be adjusted twice or more.…”

“…Additionally, since bony landmarks at the surgical site used in the process of guide pin implantation often need to be visualized clearly with uoroscopy, patients and surgeons are subject to large amounts of harmful radiation. Consequently, the desire for decreasing complication rates, avoiding excessive radiation and improving accuracy lead to the development of computer navigation and robotassisted surgery [16,17]. Although some studies on robot-assisted pelvic fracture xation have already been reported, minimally invasive triangular osteosynthesis with robotic assistance for the treatment of USFs is still lacking.…”

The Kocher-Langenbeck approach combined with robot-aided percutaneous anterior column screw fixation for transverse-oriented acetabular fractures: a retrospective study

“…Consequently, the retrograde anterior column screws aren’t suitable for the fixation of transverse acetabular fractures. Some recent studies reported that percutaneous fixation with surgical navigation is increasingly minimally invasive and safe [ 17 , 18 , 22 ]. Robot-aided orthopedic surgery has recently emerged as a more viable tool to enable higher precision surgery, as well as saving surgical time [ 17 , 18 ].…”

“…Due to the uncertain entry point and the narrow bony corridor, it usually takes much time to insert the guiding wire accurately, with the consequence of excessive radiation exposure to patients and surgeons. Percutaneous fixation under the guidance of orthopedic robots has been reported with the advantages of accuracy and convenience [ 17 , 18 ]. Most important of all, robot-aided technology can also assist surgeons to plan, simulate and correct the trajectory of screws intraoperatively [ 17 , 18 ].…”

“…Percutaneous fixation under the guidance of orthopedic robots has been reported with the advantages of accuracy and convenience [ 17 , 18 ]. Most important of all, robot-aided technology can also assist surgeons to plan, simulate and correct the trajectory of screws intraoperatively [ 17 , 18 ]. So far, the percutaneous anterior column screw fixation is possibly to be an optimal choice for the patients suffering TOAFs, especially with transverse and transverse with posterior wall fractures.…”