What is the difference between orthopedic intelligent robot-assisted nailing and freehand nailing?

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Orthopaedic intelligent robot is an intelligent device to promote the development and popularization of precise and minimally invasive surgery, which can provide full support for doctors’ decision-making and operation from vision, touch and hearing, expanding doctors’ operation skills and effectively improving the quality of surgical diagnosis and assessment, target localization, precision operation and surgery.

Pedicle screws are widely used in the treatment of spinal diseases, and the technique of feeding the screws is the key to the success of the surgery. Different individuals, different disease deformities, and different segments of the pedicle have morphological differences, and if the position of the spinal screws is deviated or displaced, it may lead to the failure of the surgery of the patient, aggravation of the symptoms, or even paralysis, death and other serious consequences. Therefore, orthopedic intelligent robot-assisted spinal surgery has emerged. The following clinical data illustrate the difference between orthopedic intelligent robot-assisted spinal screw placement and unarmed spinal screw placement.

Orthopedic intelligent robot-assisted nail placement

The researchers selected 100 patients who underwent foraminal lumbar interbody fusion (TLIF) from February 2016 to May 2018, and divided them into the RA group with robotic-assisted nailing and the FG group with unarmed nailing under the guidance of traditional open imaging equipment. The enrolled patients were all diagnosed with lumbar degenerative disease on fluoroscopy and had no symptomatic relief after no less than 6 months of conservative treatment. The patients were free to choose the surgical procedure after the physicians were fully briefed about the two procedures. The surgeries were performed by 2 physicians, and each physician independently performed 25 surgeries in each of the RA and FG groups.

Based on postoperative CT, 3 indicators were evaluated: FJV rating, distance of pedicle screws from the proximal planar joint, and accuracy of apical screws (2 apical screws per patient) in the pedicle. Patient information, perioperative outcomes, and radiation exposure times were also recorded and compared in the study. Perioperative outcomes included operative time, intraoperative blood loss, postoperative hospital days, and revision surgery.

NOTE: FJV ratings were assessed according to the method proposed by Babu et al. Grade 0 was no infringement; grade 1 bit of pedicle screw nail rod and/or nail head was less than 1 mm away from the planar joint without significant joint infringement; grade 2 was screw contact with the planar joint; and grade 3 was pedicle screw crossing the articular surface.

RESULTS: Planar joint infringement rates and ratings: of the 100 apical screws in the RA group, 4 infringed on the proximal planar joints, compared with 26 of the 100 screws in the FG group (P=0.000).For FJV screw ratings, 3 screws were rated as 1, and 1 screw was rated as 2, respectively, in the RA group; in the FG group, there were 26 FJV screws, with 17 screws rated as 1, 6 screws rated as 2 and 3 screws scored 3. The FG group had significantly more FJV screws than the RA group (P=0.000). There was a statistically significant difference between the RA group and the FG group in terms of overall level of invasion (0.05 vs 0.38, P=0.000). In terms of distance between pedicle screws and planar joints, the RA group (4.16±2.60 mm) was significantly higher than the FG group (1.92±1.55 mm), (P=0.000).

Pedicle screw accuracy: the screw position excellence rate was significantly higher in the RA group than in the FG group (85% vs 71%, P=0.017).

Radiation exposure time: significantly more in the FG group than in the RA group (30.3 ± 11.3 vs. 65.3 ± 28.3 μSv; P = 0.000).

Operative time: significantly more in the RA group than in the FG group (184.7 ± 54.3 vs. 117.8 ± 36.9 min; P = 0.000).

Blood loss: significantly more in the FG group than in the RA group (171.6 ± 123.1 mL vs. 362.0 ± 356.8 mL, P = 0.001)

Postoperative hospitalization days: less in the RA group than in the FG group (5.1 ± 1.0 days VS 5.6 ± 2.6 days, P = 0.157), but not statistically different.

Revision: one patient in the FG group had persistent postoperative radiating pain due to malpositioned screws and eventually underwent revision surgery

CONCLUSION: Robotic-assisted spine surgery has less proximal planar joint invasion and is more distant from the planar joints, higher accuracy of intraspinal screws, shorter ray exposure time, and less blood loss than traditional open intraoperative imaging device-assisted freehand surgery.

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