2023, Vol. 27 ›› Issue (27): 4332-4336

Comparison of robot-assisted and free-hand cortical bone trajectory screw in lumbar spinal surgery for senile osteoporosis

Ma Sai, Liu Bo, Li Nan, He Da   

Abstract: BACKGROUND: Compared with pedicle screws, cortical bone trajectory screws can improve the holding force, but they have longer learning curve and high misplacement rate. Orthopedic robots can overcome the above limitations and improve the accuracy and safety of screw placement.  
OBJECTIVE: To compare the accuracy and safety of robot-assisted with those of free-hand cortical bone trajectory screw placement in senile osteoporotic patients with lumbar spinal surgery.
METHODS: From June 2015 to March 2021, data of patients aged ≥65 years old with osteoporosis, who underwent lumbar cortical bone trajectory screw instrumentation in Beijing Jishuitan Hospital, were retrospectively analyzed. A total of 64 patients were included in the study. In the robot group (n=23), 92 TiRobot-assisted cortical bone trajectory screws were implanted. In the free-hand group (n=41), 164 cortical bone trajectory screws were implanted. The modified Gertzbein-Robbins scale was used to assess the accuracy of screw placement and the incidence of proximal facet joint violation. Operative time, intraoperative blood loss, postoperative hospital stay, and complications were observed.  
RESULTS AND CONCLUSION: (1) In the robot group, the proportion of clinically acceptable screws (97.8%) was significantly higher than the 87.2% in the free-hand group (P < 0.001). (2) There was no statistically significant difference in the rate of cephalic facet joint violation between the robot and free-hand groups (P = 0.157). (3) There was no statistically significant difference in the blood loss, postoperative hospital stay, or wound infection between the two groups. (4) These findings indicate that in osteoporotic patients with lumbar spine surgery, robot-assisted placement of cortical bone trajectory screw is more accurate and safe compared with free-hand placement.

Key words: robotic surgery, free hand, cortical bone trajectory, safety, accuracy