Effectiveness comparison of robot-assisted and traditional freehand technology in treatment of atlantoaxial dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Haiping ¹ ,  HAO Dingjun ¹ , HE Baorong ¹ , XU Zhengwei ¹ , DUAN Yongchao ² , YANG Wenlong ¹ , LI Houkun ¹ , KOU Changjiang ³ , WANG Ke ³

1. Department of Spine Surgery, Xi’an Jiaotong University Affiliated Honghui Hospital, Xi’an Shaanxi, 710054, P. R. China;
2. Department of Intraoperative Radiology, Honghui Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China;
3. Xi’an Medical College, Xi’an Shaanxi, 710068 P. R. China;

Corresponding author：

HAO Dingjun, Email: haodingjun@126.com

Keywords：

Robot-assisted technology; freehand screw placement; atlantoaxial dislocation; accuracy

DOI：

10.7507/1002-1892.202405006

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Objective To compare the effectiveness of robot-assisted and traditional freehand screw placement in the treatment of atlantoaxial dislocation. Methods The clinical data of 55 patients with atlantoaxial dislocation who met the selection criteria between January 2021 and January 2024 were retrospectively analyzed. According to different screw placement methods, they were divided into the traditional group (using the traditional freedhand screw placement, 31 cases) and the robot group (using the Mazor X robot-assisted screw placement, 24 cases). There was no significant difference in gender, age, body mass index, etiology, and preoperative visual analogue scale (VAS) score, cervical spine Japanese Orthopaedic Association (JOA) score between the two groups (P>0.05). The operation time, intraoperative blood loss, operation cost, and intraoperative complications were recorded and compared between the two groups. The VAS score and cervical spine JOA score were used to evaluate the improvement of pain and cervical spinal cord function before operation and at 1 month after operation. CT examination was performed at 3 days after operation, and the accuracy of screw placement was evaluated according to Neo grading criteria. Results All the 55 patients successfully completed the operation. The operation time, intraoperative blood loss, and operation cost in the robot group were significantly higher than those in the traditional group (P<0.05). A total of 220 C₁ and C₂ pedicle screws were inserted in the two groups, and 94 were inserted in the robot group, with an accuracy rate of 95.7%, among them, 2 were inserted by traditional freehand screw placement due to bleeding caused by intraoperative slip. And 126 pedicle screws were inserted in the traditional group, with an accuracy rate of 87.3%, which was significantly lower than that in the robot group (P<0.05). There were 1 case of venous plexus injury in the robot group and 3 cases in the traditional group, which improved after pressure hemostasis treatment. No other intraoperative complication such as vertebral artery injury or spinal cord injury occurred in both groups. All patients were followed up 4-16 months with an average of 6.6 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). Postoperative neck pain significantly relieved in both groups, and neurological symptoms relieved to varying degrees. The VAS score and cervicle spine JOA score of both groups significantly improved at 1 month after operation when compared with preoperative scores (P<0.05), and there was no significant difference in the score change between the two groups (P>0.05). Conclusion In the treatment of atlantoaxial dislocation, the accuracy of robot-assisted screw placement is superior to the traditional freedhand screw placement.

Citation： ZHANG Haiping, HAO Dingjun, HE Baorong, XU Zhengwei, DUAN Yongchao, YANG Wenlong, LI Houkun, KOU Changjiang, WANG Ke. Effectiveness comparison of robot-assisted and traditional freehand technology in treatment of atlantoaxial dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(8): 917-922. doi: 10.7507/1002-1892.202405006 Copy

1.	Khan ASR, Currier BL, Erickson MM, et al. C₁-C₂ posterior screw-rod fixation. Instr Course Lect, 2024, 73: 651-664.
2.	Garst J, Olson E, Kahn M, et al. Temporary posterior C₁-C₂ instrumentation without fusion for treatment of displaced atlantoaxial fractures. World Neurosurg, 2022, 164: e718-e723.
3.	Zileli M, Akıntürk N. Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up. Eur Spine J, 2022, 31(2): 311-326.
4.	O’Connor TE, O’Hehir MM, Khan A, et al. Mazor X stealth robotic technology: A technical note. World Neurosurg, 2021, 145: 435-442.
5.	McIntosh MK, Christie S. Opportunities and challenges for robotic-assisted spine surgery: feasible indications for the MAZOR^TM X Stealth Edition. Annu Int Conf IEEE Eng Med Biol Soc, 2023, 2023: 1-4.
6.	陈文创, 李勇, 鲁尧, 等. 机器人辅助椎弓根螺钉内固定治疗寰枢椎脱位. 中国组织工程研究, 2024, 28(36): 5833-5838.
7.	Neo M, Sakamoto T, Fujibayashi S, et al. The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine (Phila Pa 1976), 2005, 30(24): 2800-2805.
8.	Olinger C, Bransford R. Upper cervical trauma. Orthop Clin North Am, 2021, 52(4): 451-479.
9.	Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J, 2012, 21(2): 247-255.
10.	吴超, 邓佳燕, 谭伦, 等. 逐级扩大型3D打印导板系统辅助寰枢椎椎弓根植钉准确性分析及临床应用. 中国修复重建外科杂志, 2019, 33(2): 212-218.
11.	Sun J, Wu D, Wang Q, et al. Pedicle screw insertion: Is O-arm-based navigation superior to the conventional freehand technique? A systematic review and meta-analysis. World Neurosurg, 2020, 144: e87-e99.
12.	曲哲, 钱邦平, 邱勇, 等. O型臂3D导航与徒手置钉在上颈椎椎弓根螺钉置入中的精确性比较. 中国脊柱脊髓杂志, 2015, 25(12): 1063-1068.
13.	Fatima N, Massaad E, Hadzipasic M, et al. Safety and accuracy of robot-assisted placement of pedicle screws compared to conventional free-hand technique: a systematic review and meta-analysis. Spine J, 2021, 21(2): 181-192.
14.	Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976), 2007, 32(3): E111-E120.
15.	Siddiqui MI, Wallace DJ, Salazar LM, et al. Robot-assisted pedicle screw placement: Learning curve experience. World Neurosurg, 2019, 130: e417-e422.
16.	Kam JKT, Gan C, Dimou S, et al. Learning curve for robot-assisted percutaneous pedicle screw placement in thoracolumbar surgery. Asian Spine J, 2019, 13(6): 920-927.
17.	Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019, 30(5): 615-622.
18.	Keric N, Doenitz C, Haj A, et al. Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws. Neurosurg Focus, 2017, 42(5): E11. doi: 10.3171/2017.2.FOCUS16552.
19.	Kuris EO, Anderson GM, Osorio C, et al. Development of a robotic spine surgery program: Rationale, strategy, challenges, and monitoring of outcomes after implementation. J Bone Joint Surg (Am), 2022, 104(19): e83. doi: 10.2106/JBJS.22.00022.

1. Khan ASR, Currier BL, Erickson MM, et al. C₁-C₂ posterior screw-rod fixation. Instr Course Lect, 2024, 73: 651-664.
2. Garst J, Olson E, Kahn M, et al. Temporary posterior C₁-C₂ instrumentation without fusion for treatment of displaced atlantoaxial fractures. World Neurosurg, 2022, 164: e718-e723.
3. Zileli M, Akıntürk N. Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up. Eur Spine J, 2022, 31(2): 311-326.
4. O’Connor TE, O’Hehir MM, Khan A, et al. Mazor X stealth robotic technology: A technical note. World Neurosurg, 2021, 145: 435-442.
5. McIntosh MK, Christie S. Opportunities and challenges for robotic-assisted spine surgery: feasible indications for the MAZOR^TM X Stealth Edition. Annu Int Conf IEEE Eng Med Biol Soc, 2023, 2023: 1-4.
6. 陈文创, 李勇, 鲁尧, 等. 机器人辅助椎弓根螺钉内固定治疗寰枢椎脱位. 中国组织工程研究, 2024, 28(36): 5833-5838.
7. Neo M, Sakamoto T, Fujibayashi S, et al. The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine (Phila Pa 1976), 2005, 30(24): 2800-2805.
8. Olinger C, Bransford R. Upper cervical trauma. Orthop Clin North Am, 2021, 52(4): 451-479.
9. Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J, 2012, 21(2): 247-255.
10. 吴超, 邓佳燕, 谭伦, 等. 逐级扩大型3D打印导板系统辅助寰枢椎椎弓根植钉准确性分析及临床应用. 中国修复重建外科杂志, 2019, 33(2): 212-218.
11. Sun J, Wu D, Wang Q, et al. Pedicle screw insertion: Is O-arm-based navigation superior to the conventional freehand technique? A systematic review and meta-analysis. World Neurosurg, 2020, 144: e87-e99.
12. 曲哲, 钱邦平, 邱勇, 等. O型臂3D导航与徒手置钉在上颈椎椎弓根螺钉置入中的精确性比较. 中国脊柱脊髓杂志, 2015, 25(12): 1063-1068.
13. Fatima N, Massaad E, Hadzipasic M, et al. Safety and accuracy of robot-assisted placement of pedicle screws compared to conventional free-hand technique: a systematic review and meta-analysis. Spine J, 2021, 21(2): 181-192.
14. Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976), 2007, 32(3): E111-E120.
15. Siddiqui MI, Wallace DJ, Salazar LM, et al. Robot-assisted pedicle screw placement: Learning curve experience. World Neurosurg, 2019, 130: e417-e422.
16. Kam JKT, Gan C, Dimou S, et al. Learning curve for robot-assisted percutaneous pedicle screw placement in thoracolumbar surgery. Asian Spine J, 2019, 13(6): 920-927.
17. Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial. J Neurosurg Spine, 2019, 30(5): 615-622.
18. Keric N, Doenitz C, Haj A, et al. Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws. Neurosurg Focus, 2017, 42(5): E11. doi: 10.3171/2017.2.FOCUS16552.
19. Kuris EO, Anderson GM, Osorio C, et al. Development of a robotic spine surgery program: Rationale, strategy, challenges, and monitoring of outcomes after implementation. J Bone Joint Surg (Am), 2022, 104(19): e83. doi: 10.2106/JBJS.22.00022.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison of robot-assisted and traditional freehand technology in treatment of atlantoaxial dislocation

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