Robot-assisted intravertebral augmentation corrects local kyphosis more effectively than a conventional fluoroscopy-guided technique

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Intravertebral augmentation (IVA) is a reliable minimally invasive technique for treating Magerl type A vertebral body fractures. However, poor correction of kyphotic angulation, the risk of cement leakage, and significant exposure to radiation (for the surgeon, the operating room staff, and the patient) remain significant issues. The authors conducted a study to assess the value of robot-assisted IVA (RA-IVA) for thoracolumbar vertebral body fractures.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors performed a retrospective, single-center study of patients who had undergone RA-IVA or conventional fluoroscopy-guided IVA (F-IVA) for thoracolumbar vertebral body fractures. Installation and operating times, guidance accuracy, residual local kyphosis, degree of restoration of vertebral body height, incidence of cement leakage, rate of morbidity, length of hospital stay, and radiation-related data were recorded.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Data obtained in 30 patients who underwent RA-IVA were compared with those obtained in 30 patients who underwent F-IVA during the same period (the surgical indications were identical, but the surgeons were different). The mean ± SD installation time in the RA-IVA group (24 ± 7.5 minutes) was significantly shorter (p = 0.005) than that in the F-IVA group (26 ± 8 minutes). The mean operating time for the RA-IVA group (52 ± 11 minutes) was significantly longer (p = 0.026) than that for the F-IVA group (30 ± 11 minutes). All RA-IVAs and F-IVAs were Ravi’s scale grade A (no pedicle breach). The mean degree of residual local kyphosis (4.7° ± 3.15°) and the percentage of vertebral body height restoration (63.6% ± 21.4%) were significantly better after RA-IVA than after F-IVA (8.4° ± 5.4° and 30% ± 34%, respectively). The incidence of cement leakage was significantly lower in the RA-IVA group (p &lt; 0.05). The mean length of hospital stay after surgery was 3.2 days for both groups. No surgery-related complications occurred in either group. With RA-IVA, the mean radiation exposure was 438 ± 147 mGy × cm for the patient and 30 ± 17 mGy for the surgeon.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>RA-IVA provided better vertebral body fracture correction than the conventional F-IVA. However, RA-IVA requires more time than F-IVA.</jats:p></jats:sec>

Robot-Assisted Versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture: A Retrospective Study

“…Han et al 20 reported that the operation time of RA thoracolumbar spine internal fixation surgery was 149.5 + 50.8 mins, which was slightly longer than that of the FA of 138.0 + 48.6 mins, but there was no statistical difference between the 2 methods. However, Alsalmi et al 21 reported that RA intravertebral augmentation was 52 + 11 mins, which was significantly longer than that of C-arm assisted surgery of 30 + 11 mins. In this study, the operation time of RA surgery for single segment fractures was significantly longer than that of the FA surgery.…”

“…In other navigation technique assisted PKP studies, the VAS improved dramatically after surgery without difference compared with FA group. 21,22 Radiation exposure during operation is an occupational risk for orthopedic surgeons. Mastrangelo et al 27 found that orthopedic surgeons have a high incidence of tumor due to radiation exposure.…”

“…So far, few studies of navigation technique assisted PKP reported the restoration of compressed vertebrae. Alsalmi et al 21 studied “ROSA ® ” robot-assisted intervertebral augmentation, and the results showed that the mean degree of residual local kyphosis (4.7°) and the percentage of vertebral body height restoration (63.6%) were significantly better after RA than these after FA technique (8.4° and 30%, respectively), but the authors did not explain the reason why the RA could correct more kyphosis and vertebral body height than the FA technique. Zhang et al 22 compared OVCF patients receiving O-arm 3D reconstructed intraoperative images navigation assisted PKP with fluoroscopy assisted PKP, and they reported that there was no difference in the restoration of the compressed vertebrae.…”

“…In other navigation technique assisted PKP studies, the VAS improved dramatically after surgery without difference compared with FA group. 21 , 22 …”

“…It has been reported that “SpineAssist ® ” and “Rosa ® ” spinal robot assisted PKP can reduce the radiation exposure of surgeons or patients compared with fluoroscopy assisted PKP surgery during the operation. 12 , 21 The “TiRobot ® ” robot in lumbar spinal instrumentation surgery could reduce the radiation exposure of surgeons, but it may increase the radiation exposure of patients. 28 In the current study, we found that the patients in the RA group received significantly higher fluoroscopy frequency, longer exposure time and higher total radiation dose than those in the FA group.…”