Radiographic and Clinical Outcomes of Robot-Assisted Posterior Pedicle Screw Fixation: Two-Year Results from a Randomized Controlled Trial

• Published in: Yonsei medical journal Vol. 59; no. 3; pp. 438 - 444
• Main Authors: Park, Sang-Min, Kim, Ho-Joong, Lee, Se Yeon, Chang, Bong-Soon, Lee, Choon-Ki, Yeom, Jin S.
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.05.2018; 연세대학교의과대학
• Subjects: Adult; Aged; Female; Humans; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Male; Middle Aged; Original; Pain Measurement; Pedicle Screws; Prospective Studies; Radiography; Range of Motion, Articular; Robotics; Spinal Fusion - instrumentation; Spinal Fusion - methods; Treatment Outcome; Visual Analog Scale; Zygapophyseal Joint; 의학일반; robot-assisted pedicle screw fixation; adjacent segment degeneration; Freehand technique; posterior lumbar interbody fusion
• ISSN: 0513-5796; 1976-2437; 1976-2437
• DOI: 10.3349/ymj.2018.59.3.438

We prospectively assessed the early radiographic and clinical outcomes (minimum follow-up of 2 years) of robot-assisted pedicle screw fixation (Robot-PSF) and conventional freehand pedicle screw fixation (Conv-PSF). Patients were randomly assigned to Robot-PSF (37 patients) or Conv-PSF (41 patients) for posterior interbody fusion surgery. The Robot-PSF group underwent minimally invasive pedicle screw fixation using a pre-planned robot-guided screw trajectory. The Conv-PSF underwent screw fixation using the freehand technique. Radiographic adjacent segment degeneration (ASD) was measured on plain radiographs, and clinical outcomes were measured using visual analogue scale (VAS) and Oswestry disability index (ODI) scores regularly after surgery. The two groups had similar values for radiographic ASD, including University California at Los Angeles grade, vertebral translation, angular motion, and loss of disc height (p=0.320). At final follow-up, both groups had experienced significant improvements in back VAS, leg VAS, and ODI scores after surgery (p<0.001), although inter-group differences were not significant for back VAS (p=0.876), leg VAS (p=0.429), and ODI scores (p=0.952). In the Conv-PSF group, revision surgery was required for two of the 25 patients (8%), compared to no patients in the Robot-PSF group. There were no significant differences in radiographic ASD and clinical outcomes between Robot-PSF and Conv-PSF. Thus, the advantages of robot-assisted surgery (accurate pedicle screw insertion and minimal facet joint violation) do not appear to be clinically significant.