Robotic steerage for percutaneous minimally invasive placement of pedicle screws for pyogenic spondylodiscitis is related to decrease charges of wound breakdown in comparison with typical fluoroscopy-guided instrumentation.
Neurosurg Rev. 2018 Apr;41(2):489-496
Authors: Alaid A, von Eckardstein Okay, Smoll NR, Solomiichuk V, Rohde V, Martinez R, Schatlo B
Postoperative wound therapeutic can pose an issue in sufferers present process instrumented surgical procedure for pyogenic spondylodiscitis. Robotic steerage permits the minimally invasive placement of pedicle screws within the thoracolumbar backbone. We assessed whether or not utilizing this method to carry out minimally invasive surgical procedure had an impression on wound therapeutic in sufferers with pyogenic spondylodiscitis when in comparison with typical open fluoroscopy-guided surgical procedure. We reviewed charts of 206 consecutive sufferers who underwent instrumentation for pyogenic spondylodiscitis. The necessity for wound revision was the first consequence measure. Affected person variables and comorbidities in addition to surgical method (robotic versus fluoroscopy-guided) have been analyzed. We additionally in contrast fluoroscopy occasions between the 2 teams. Multivariate regression evaluation was carried out to establish predictors of wound breakdown. A complete of 206 sufferers underwent surgical procedure for spondylodiscitis. Robotic surgical help was used for percutaneous instrumentation in 47.6% of instances (n = 98). Wound therapeutic issues requiring revision occurred in 30 out of 206 sufferers (14.6%). Univariate evaluation revealed a possible affiliation of wound breakdown with (1) robotic method, (2) age > 70 years, and (three) the presence of methicillin-resistant Staphylococcus aureus. After multivariate correction nonetheless, solely robotic method retained significance with an odds ratio of Zero.39 (CI 95% Zero.16-Zero.94; p = Zero.035). Wound revision was required in eight out of 98 sufferers (eight.1%) within the robotic group and 22/108 (20%) within the typical surgical procedure group. Fluoroscopy occasions have been considerably decrease within the robotic group with a imply of 123 ± 86 s as compared with a imply of 157 ± 99 s within the typical group (p = Zero.Zero14). Whereas initially designed to enhance the accuracy of pedicle screw placement, robot-assisted minimally invasive method had a tangible impact on each radiation publicity and the speed of wound breakdown in sufferers with pyogenic spondylodiscitis in our giant single-center examine.
PMID: 28726010 [PubMed – indexed for MEDLINE]