2022, Vol. 26 ›› Issue (36): 5812-5818

Robot-assisted minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: accuracy and safety of screw placement

Li Ting1, 2, Liu Xilin1, Wang Fei1, Hu Jiang1   

Abstract: BACKGROUND: For the treatment of lumbar degenerative disorders, there are no relevant studies whether robot-assisted minimally invasive transforaminal lumbar interbody fusion is more accurate, less invasive, and more beneficial to the health of patients and operators compared with traditional minimally invasive transforaminal lumbar interbody fusion.
OBJECTIVE: To evaluate the clinical value of robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery by comparing the clinical and radiographic data with conventional minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases.  
METHODS: A retrospective study was conducted in 72 patients with lumbar degenerative diseases from January 2018 to November 2020 in Department of Orthopedic Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital.   Of them, 33 patients underwent robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery (robot group) and 39 patients received conventional minimally invasive transforaminal lumbar interbody fusion surgery (traditional group). Basic clinical outcomes included comparison of operative time, intraoperative blood loss, hospital stay, operative complications, fluoroscopic dose, fluoroscopic time and fluoroscopic frequency between the two groups. Clinical outcomes were assessed using Oswestry disability index and visual analogue scale score. Excellent and good rate of the two surgical options was evaluated using Macnab’s criteria. Gertzbein-Robbins’ classification was used to evaluate the accuracy of percutaneous pedicle screws.   
RESULTS AND CONCLUSION: (1) There were no statistically significant differences in gender, age and lesion segment between the two groups (P > 0.05). (2) Patients in both traditional and robot groups had improved Oswestry disability index and visual analogue scale scores. There were no statistically significant differences between the two groups at pre-operation, post-operation and at the last follow-up (P > 0.05). No major vascular or neurological complications were found post-operatively in both groups. Moreover, there was no statistical significance in Macnab criteria and complications between the two groups (P > 0.05). (3) Operative time and hospital stay of the robot group were significantly shorter than those in the traditional group. The intraoperative blood loss was significantly lower in the robot group than that in the traditional group. (4) The significantly lower fluoroscopic frequency and dose, as well as shorter fluoroscopic time were found in the robot group compared with the traditional group. (5) Postoperative imaging studies showed that the accuracy of percutaneous pedicle screw placement in the robot group was superior than that in the traditional group (99.24% vs. 91.03%, χ2=9.78, P=0.002). (6) It is concluded that compared with the traditional group, the robot-assisted minimally invasive transforaminal lumbar interbody fusion has higher surgical efficiency, less intraoperative radiation and superior accuracy of screw fixation, which has a good clinical value in the treatment of lumbar degenerative diseases.
Key words: surgery robot, minimally invasive, lumbar vertebrae, lumbar degenerative diseases, spinal fusion, radiation safety