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| SONG Jipeng,LIN Wancheng,YAO Siyuan.Comparison of clinical efficacies between cortical bone trajectory screw and pedicle screw fixation techniques under robot-assisted technology in posterior lumbar short-segment decompression and fusion[J].Chinese Journal of Spine and Spinal Cord,2023,(12):1098-1106. |
| Comparison of clinical efficacies between cortical bone trajectory screw and pedicle screw fixation techniques under robot-assisted technology in posterior lumbar short-segment decompression and fusion |
| Received:February 05, 2023 Revised:September 30, 2023 |
| English Keywords:Robot-assisted cortical bone trajectory screw placement Robot-assisted pedicle screw placement Lumbar spinal stenosis Single segment Decompression and fusion |
| Fund:“扬帆”计划第二批次的重点扶持专业项目（ZYLX202135）；北京市自然科学基金-海淀原始创新联合基金前沿项目（L202053） |
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| English Abstract: |
| 【Abstract】 Objectives: To compare the clinical efficacy between robot-assisted cortical bone trajectory screw(RCBTS) and robot-assisted pedicle screw(RPS) for patients with lumbar spinal stenosis(LSS) undergoing single-level decompression and fusion. Methods: In this retrospective cohort study, LSS patients who underwent robot-assisted single-level decompression and fusion in Beijing Shijitan Hospital between June 2020 and June 2022 were reviewed. A total of 99 patients were included and divided into RCBTS group of 41 patients and RPS group of 58 patients. There were 59 males and 40 females, with an average age of 67.07±4.65 years old. The incision length, operative time, intraoperative blood loss, 24h postoperative drainage, and postoperative hospital stay were compared between groups. The Japanese Orthopaedic Association(JOA) score and visual analogue scale(VAS) of low back pain were compared at 3d, 3 months and 6 months after operation, and the fixed effects of JOA score and VAS score changes were tested. The screw positions were graded according to the Gertzbein-Robbins method. The accuracy of screw placement of the two surgical methods was evaluated by reviewing the postoperative imaging data. The perioperative and postoperative 3 months of complications were compared between the two groups. Results: There were no significant differences in baseline data between the two groups(P<0.05). Comparing with the RPS group, the RCBTS group was shorter in operative time(134.39±22.23min vs 152.93±19.10min, P<0.001), smaller in incision length(64.93±3.71mm vs 78.84±3.82mm, P<0.001), less in intraoperative blood loss(155.61±37.15mL vs 172.41±43.22mL, P=0.001) and postoperative drainage within 24h(83.66±21.54mL vs 101.21±29.80mL, P=0.002), and shorter in postoperative hospital stay(4.90±1.26d vs 6.26±1.66d, P<0.001), with statistical significance. There was no significant difference in JOA score and VAS score changes between the two groups at each time point(P>0.05). The fixed effect test showed that time was a fixed effect of JOA and VAS score changes(P<0.001). The RCBTS group was no significantly different from the RPS group in the accuracy of screw placement(grade A: 152/164 vs 211/232, P=0.538; grade B: 9/164 vs 15/232, P=0.688; grade C: 3/164 vs 6/232, P=0.619), the rate of clinically acceptable screw placement(161/164 vs 226/232, P=0.619), the rate of bad screw placement(3/164 vs 6/232, P=0.619), and the incidence of postoperative complications(only 1 patient in the RCBTS group developed delayed wound healing)(P>0.05). Conclusions: Compared with RPS, RCBTS has significant advantages in operative time, incision length, intraoperative blood loss, volume of postoperative drainage, and postoperative hospital stay. However, there is no significant difference between the two groups in terms of postoperative functional recovery and alleviation in low back pain. |
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