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Published on: November 8, 2024
[Comparison of clinical outcomes between robot-assisted and conventional percutaneous pedicle screw fixation for
Haiping Cai1, Wenbin Xu1, Chang Ge1
1Department of Orthopaedics, Institute for Leading Medicine and Advanced Technologies, the First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Hefei 230001, Anhui, China.
Objective:
To compare the short-term efficacy of robot-assisted percutaneous pedicle screw fixation versus traditional percutaneous pedicle screw fixation in treating lumbar vertebral fractures, and to evaluate the differences in surgical benefits for different types of stable fractures based on AO classification.
Methods:
A retrospective analysis was conducted on 47 patients with single-segment lumbar vertebral fractures admitted between January 2023 and December 2024. Patients were classified by AO type as stable fractures (A1/A2:22 cases) or unstable fractures (A3/B1-B2:25 cases);by surgical approach as robot-assisted percutaneous group (robot group) or conventional percutaneous group (traditional group). Among stable fractures, the robot group comprised 10 cases and the conventional group 12 cases;among unstable fractures, the robot group included 11 cases and the conventional group 14 cases. Perioperative parameters (operational time, intraoperative blood loss, postoperative hospitalization duration), visual analogue scale(VAS), Oswestry disability index(ODI), and anterior vertebral height(AVH) were compared between the two groups.
Results:
All patients were followed up for 12 months. In stable fractures, the robot group exhibited significantly lower intraoperative blood loss (23.50±7.47) mL compared to the conventional group (32.50±9.65) mL (P=0.026), whereas no statistically significant differences were observed in operative time, postoperative hospitalization duration, VAS, ODI, and AVH scores at different time points before and after surgery between the two groups (all P>0.05). In unstable fractures, the robot group demonstrated superior surgical duration (64.09±11.36) min, intraoperative blood loss (27.73±12.92) mL, and postoperative hospitalization time (5.91±1.45) days compared to the conventional group (77.86±18.78) min, (46.79±20.34) mL, and (7.64±2.02) days, respectively, with all differences being statistically significant (P<0.05). On day 1 postoperatively, the VAS in the robotic group was (2.27±0.79) scores, significantly lower than that of the conventional group (3.43±0.94) scores (P=0.003), although no statistically significant difference was observed between the two groups at the 12 month after surgery (P=0.159). The ODI at day 1 and 12 months postoperatively were (26.55±6.56) and (8.27±2.10) respectively in the robot group, both significantly better than those of the conventional group (41.64±12.11) and (13.57±4.03), respectively (P<0.05). The AVH measurements at day 1 and 12 months postoperatively were (2.41±0.56) cm and (2.22±0.55) cm in the robot group, significantly higher than those of the conventional group (2.02±0.31) cm and (1.87±0.30) cm, respectively(P<0.05).
Conclusion:
For unstable lumbar fractures(A3/B1-B2), robot-assisted percutaneous pedicle screw fixation provides superior short-term analgesia, functional recovery, vertebral height reconstruction, and certain perioperative outcomes;for stable fractures (A1/A2), the clinical and imaging outcomes of both techniques are generally comparable, but the robotic approach offers perioperative advantages in reducing intraoperative bleeding.
