Comparison of rostral facet joint violations in robotic- and navigation-assisted pedicle screw placement for adult lumbar spine instrumentation.

Autor: Nilssen PK; Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Narendran N; Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Skaggs DL; Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Tuchman A; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Walker CT; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Perry TG; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Tiffany.perry@cshs.org.
Jazyk: angličtina
Zdroj: The spine journal : official journal of the North American Spine Society [Spine J] 2024 Nov; Vol. 24 (11), pp. 2102-2109. Date of Electronic Publication: 2024 Aug 12.
DOI: 10.1016/j.spinee.2024.07.008
Abstrakt: Background Context: Facet joint violation by pedicle screws may lead to adjacent-segment disease and postoperative pain. Previous studies have reported the incidence of rostral facet joint violation using various pedicle screw insertion techniques. However, the incidence of facet joint violations with robotic guidance has not been determined.
Purpose: To investigate and compare the incidence of rostral facet joint violation by pedicle screws under robotic guidance and computerized tomography (CT) navigation guidance.
Study Design/setting: Retrospective matched cohort.
Patient Sample: All patients who underwent robotic-assisted lumbar fusion at a major spine center up until 2023 were retrospectively identified and matched 1:3 to patients undergoing CT navigation guidance based by on age, sex, rostral vertebral level, and length of construct. Inclusion criteria consisted of age greater than 18 years, bilateral pedicle screw fixation, and presence of a postoperative CT scan of the lumbar spine or abdomen/pelvis at any point in the postoperative period.
Outcome Measures: Rostral facet joint violations.
Methods: Descriptive statistics were used to compare cohorts: frequencies, chi-squared analysis for categorical variables, and t-test for continuous variables.
Results: A total of 408 rostral pedicle screws were implanted in 204 patients (Robot: 102; Navigation: 306). Overall, 13 (12.3%) rostral facet joint violations were observed in the robot cohort and 75 (24.5%) in the navigation cohort (p=.01). Specifically, fewer robotic violations were observed at the L2 (3.5% vs 32.1%, p=.003) and L3 levels (3.9% vs 18.1%, p=.08) compared to navigation. No difference was observed at L4 and L5. Bilateral violations are significantly reduced with robotic approaches (5.3% vs 14.4%, p=.03). Lastly, more facet joint violations were observed during open approaches (robot: 18.8%, navigation: 27.3%) than percutaneous approaches (robot: 11.6%, navigation: 7.1%) in both groups (p<.001). The rate of L4 facet violations was 18.8% in the robotic cohort and 27.3% in the navigation cohort. The rate of L5 facet violations was 31.3% in the robotic cohort and 29.2% in the navigation cohort.
Conclusions: Use of robotic assistance in lumbar pedicle screws significantly reduced the rate of rostral facet joint violations compared to navigation guidance at L2 and L3 levels, but not at L4 and L5, with facet violations approaching nearly one-third of the patients at L5 screws. Rostral facet violations can play a significant role in adjacent segment degeneration and disease. Technical factors and trajectory issues likely play a role and addressing these components should minimize unintended facet violation and proximal adding on.
Competing Interests: Declaration of competing interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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