Analysis of the Screw Accuracy and Postoperative Efficacy of Screw Placement in Single Position and Bipedal Position in Robot-Assisted Oblique Lumbar Interbody Fusion: Preliminary Results of Mazor X Stealth Usage

Abstract

Objective:: Traditional manual OLIF combined with pedicle screw implantation has many problems of manual percutaneous screw implantation, such as high difficulty of screw placement, many fluoroscopies, long operation time, and many adjustments, resulting in greater trauma. The robot can perform various types of screw placement in the lateral recumbent position, which allows OLIF combined with posterior screw placement surgery to be completed in a single position. To compare the screw accuracy and initial postoperative results of oblique anterior lumbar fusion with robot-assisted screw placement in the lateral position and screw placement in the prone position for the treatment of lumbar spondylolisthesis.

Methods:: From May to June 2022, 45 patients with single-segment lumbar spondylolisthesis underwent Mazor X-assisted oblique lumbar fusion in one position and Renaissance-assisted surgery in two different positions, and screw accuracy was assessed on computed tomography scans according to a modified Gertzbein–Robbins classification. Patients were divided into a single position group and a bipedal position group (the lateral position for complete oblique lumbar fusion and then changed to the prone position for posterior screw placement), and the perioperative parameters, including operative time, number of fluoroscopies, and operative complications, were recorded separately. The results of the clinical indicators, such as the visual analog scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) score, were obtained.

Results:: There were no significant differences in the patients' demographic data between the two groups. The single position group had a shorter operative time and fewer fluoroscopies than the bipedal position group; the single position group had a higher percentage of screw accuracy at the A level than the bipedal position group, but there was no statistically significant difference between the two groups at the acceptable level (A + B) (p > 0.05). The single-position group had better outcomes at the 1-week postoperative follow-up back pain VAS scores (p < 0.05). There was no statistically significant difference in the postoperative leg pain VAS scores or the ODI scores when compared to the control group.

Conclusion:: Robot-assisted lateral position oblique lumbar interbody fusion with pedicle screw placement has the same accuracy as prone positioning. Single position surgery can significantly shorten the operation time and reduce the fluoroscopy. There was no significant difference in the long-term efficacy between the two groups.

Keywords

Minimally invasive / Navigation / Pedicle screw accuracy / Robot / Robot assistance / Spine surgery

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