Revisions for screw malposition and scientific outcomes after robot-guided lumbar fusion for spondylolisthesis.
Neurosurg Focus. 2017 Could;42(5):E12
Authors: Schröder ML, Staartjes VE
OBJECTIVE The accuracy of robot-guided pedicle screw placement has been confirmed to be excessive, however little is thought concerning the influence of such steering on scientific outcomes comparable to the speed of revision surgical procedures for screw malposition. As well as, there are only a few knowledge concerning the influence of robot-guided fusion on patient-reported outcomes (PROs). Thus, the scientific profit for the affected person is unclear. On this research, the authors analyzed revision charges for screw malposition and adjustments in PROs following minimally invasive robot-guided pedicle screw fixation. METHODS A retrospective cohort research of sufferers who had undergone minimally invasive posterior lumbar interbody fusion (MI-PLIF) or minimally invasive transforaminal lumbar interbody fusion was carried out. Sufferers have been adopted up clinically at 6 weeks, 12 months, and 24 months after remedy and by mailed questionnaire in March 2016 as a last follow-up. Visible analog scale (VAS) scores for again and leg ache severity, Oswestry Incapacity Index (ODI), screw revisions, and socio-demographic components have been analyzed. A literature evaluation was carried out, evaluating the incidence of intraoperative screw revisions and revision surgical procedure for screw malposition in robot-guided, navigated, and freehand fusion procedures. RESULTS Seventy-two sufferers match the research inclusion standards and had a imply observe up of 32 ± 17 months. No screws needed to be revised intraoperatively, and no revision surgical procedure for screw malposition was wanted. Within the literature evaluation, the authors discovered a better fee of intraoperative screw revisions within the navigated pool than within the robot-guided pool (p < zero.001, OR 9.7). Moreover, a better incidence of revision surgical procedure for screw malposition was noticed for freehand procedures than for the robot-guided procedures (p < zero.001, OR eight.1). The VAS rating for again ache improved considerably from 66.9 ± 25.zero preoperatively to 30.1 ± 26.eight on the last follow-up, as did the VAS rating for leg ache (from 70.6 ± 22.eight to 24.three ± 28.three) and ODI (from 43.four ± 18.three to 16.2 ± 16.7; all p < zero.001). Present process PLIF, a excessive physique mass index, smoking standing, and a preoperative skill to work have been recognized as predictors of a discount in again ache. Size of hospital keep was 2.four ± 1.1 days and working time was 161 ± 50 minutes. Capability to work elevated from 38.9% to 78.2% of sufferers (p < zero.001) on the last follow-up, and 89.1% of sufferers indicated they’d select to bear the identical remedy once more. CONCLUSIONS In adults with low-grade spondylolisthesis, the info demonstrated a profit in utilizing robotic steering to cut back the speed of revision surgical procedure for screw malposition as in contrast with different strategies of pedicle screw insertion described in peer-reviewed publications. Bigger comparative research are required to evaluate variations in PROs following a minimally invasive method in spinal fusion surgical procedures in contrast with different strategies.
PMID: 28463610 [PubMed – indexed for MEDLINE]