Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis
Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the...
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| Veröffentlicht in: | Journal of robotic surgery 2017-03, Vol.11 (1), p.17-25 |
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| creator | Keric, Naureen Eum, David J. Afghanyar, Feroz Rachwal-Czyzewicz, Izabela Renovanz, Mirjam Conrad, Jens Wesp, Dominik M. A. Kantelhardt, Sven R. Giese, Alf |
| description | Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the application of intervertebral cages. In this collective, we compare conventional open to a further minimalized percutaneous robot-assisted spinal instrumentation, avoiding a direct contact of implants and infectious focus. 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments with and without decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. 24 patients were treated by free-hand fluoroscopy-guided surgery (121 screws), and 66 patients were treated by percutaneous robot-assisted spinal instrumentation (341 screws). Accurate screw placement was confirmed in 90 % of robot-assisted and 73.5 % of free-hand placed screws. Implant revision due to misplacement was necessary in 4.95 % of the free-hand group compared to 0.58 % in the robot-assisted group. The average intraoperative X-ray exposure per case was 0.94 ± 1.04 min in the free-hand group vs. 0.4 ± 0.16 min in the percutaneous group (
p
= 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (
p
= 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis. |
| doi_str_mv | 10.1007/s11701-016-0597-5 |
| format | Article |
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p
= 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (
p
= 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis.</description><identifier>ISSN: 1863-2483</identifier><identifier>EISSN: 1863-2491</identifier><identifier>DOI: 10.1007/s11701-016-0597-5</identifier><identifier>PMID: 27277255</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Abscesses ; Accuracy ; Adult ; Aged ; Aged, 80 and over ; Antibiotics ; Back surgery ; Computed tomography ; Debridement ; Decompression, Surgical - methods ; Discitis - diagnostic imaging ; Discitis - surgery ; Female ; Fluoroscopy ; Humans ; Insertion ; Instruments ; Intervertebral Disc - diagnostic imaging ; Intervertebral Disc - surgery ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Minimally Invasive Surgery ; Minimally Invasive Surgical Procedures - methods ; Original Article ; Patients ; Pedicle Screws ; Radiation dosage ; Radiography, Interventional ; Retrospective Studies ; Robotic surgery ; Robotic Surgical Procedures - instrumentation ; Robotic Surgical Procedures - methods ; Robots ; Software ; Statistical analysis ; Surgery ; Tomography, X-Ray Computed ; Trauma ; Urology</subject><ispartof>Journal of robotic surgery, 2017-03, Vol.11 (1), p.17-25</ispartof><rights>Springer-Verlag London 2016</rights><rights>Springer-Verlag London 2016.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-5256003ab7e9ddb3047ba8b16bc9c7fbc38bb11919ffed8cdb388bc1d51750923</citedby><cites>FETCH-LOGICAL-c372t-5256003ab7e9ddb3047ba8b16bc9c7fbc38bb11919ffed8cdb388bc1d51750923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11701-016-0597-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2918715243?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,21388,21389,27924,27925,33530,33531,33744,33745,41488,42557,43659,43805,51319,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27277255$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Keric, Naureen</creatorcontrib><creatorcontrib>Eum, David J.</creatorcontrib><creatorcontrib>Afghanyar, Feroz</creatorcontrib><creatorcontrib>Rachwal-Czyzewicz, Izabela</creatorcontrib><creatorcontrib>Renovanz, Mirjam</creatorcontrib><creatorcontrib>Conrad, Jens</creatorcontrib><creatorcontrib>Wesp, Dominik M. A.</creatorcontrib><creatorcontrib>Kantelhardt, Sven R.</creatorcontrib><creatorcontrib>Giese, Alf</creatorcontrib><title>Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis</title><title>Journal of robotic surgery</title><addtitle>J Robotic Surg</addtitle><addtitle>J Robot Surg</addtitle><description>Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the application of intervertebral cages. In this collective, we compare conventional open to a further minimalized percutaneous robot-assisted spinal instrumentation, avoiding a direct contact of implants and infectious focus. 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments with and without decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. 24 patients were treated by free-hand fluoroscopy-guided surgery (121 screws), and 66 patients were treated by percutaneous robot-assisted spinal instrumentation (341 screws). Accurate screw placement was confirmed in 90 % of robot-assisted and 73.5 % of free-hand placed screws. Implant revision due to misplacement was necessary in 4.95 % of the free-hand group compared to 0.58 % in the robot-assisted group. The average intraoperative X-ray exposure per case was 0.94 ± 1.04 min in the free-hand group vs. 0.4 ± 0.16 min in the percutaneous group (
p
= 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (
p
= 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis.</description><subject>Abscesses</subject><subject>Accuracy</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antibiotics</subject><subject>Back surgery</subject><subject>Computed tomography</subject><subject>Debridement</subject><subject>Decompression, Surgical - methods</subject><subject>Discitis - diagnostic imaging</subject><subject>Discitis - surgery</subject><subject>Female</subject><subject>Fluoroscopy</subject><subject>Humans</subject><subject>Insertion</subject><subject>Instruments</subject><subject>Intervertebral Disc - diagnostic imaging</subject><subject>Intervertebral Disc - surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgery</subject><subject>Minimally Invasive Surgical Procedures - methods</subject><subject>Original Article</subject><subject>Patients</subject><subject>Pedicle Screws</subject><subject>Radiation dosage</subject><subject>Radiography, Interventional</subject><subject>Retrospective Studies</subject><subject>Robotic surgery</subject><subject>Robotic Surgical Procedures - instrumentation</subject><subject>Robotic Surgical Procedures - methods</subject><subject>Robots</subject><subject>Software</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Tomography, X-Ray Computed</subject><subject>Trauma</subject><subject>Urology</subject><issn>1863-2483</issn><issn>1863-2491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1kc1q3TAQhUVpaNK0D9BNMXTTjRONdGVZyxLStBDopl0L_fmi4Gu5GuvCfYU-dWScJlDoSoPmO2dmOIR8AHoFlMprBJAUWgpdS4WSrXhFLqDveMt2Cl4_1z0_J28RHygVUnB4Q86ZZFIyIS7In9ujGYtZYpqaNDRY8j46Mza4ZLOE_Wn9dGk6hmlFauOIV80csiuLmUIq2ORk09IaxIhL8A3OccWqfMJ2Dj66MprcxKk6lkO12WbFqZJp8qcx-YguLhHfkbPBjBjeP72X5NfX258339r7H3ffb77ct45LtrSCiY5SbqwMynvL6U5a01vorFNODtbx3loABWoYgu9dRfreOvACpKCK8UvyefOdc_pdAi76UDcI47gdpKFnXad2wGVFP_2DPqSS632omYJegmA7XinYKJcTYg6DnnM8mHzSQPUalN6C0jUovQalRdV8fHIu9hD8s-JvMhVgG4C1Ne1Dfhn9f9dHkO-iSQ</recordid><startdate>20170301</startdate><enddate>20170301</enddate><creator>Keric, Naureen</creator><creator>Eum, David J.</creator><creator>Afghanyar, Feroz</creator><creator>Rachwal-Czyzewicz, Izabela</creator><creator>Renovanz, Mirjam</creator><creator>Conrad, Jens</creator><creator>Wesp, Dominik M. A.</creator><creator>Kantelhardt, Sven R.</creator><creator>Giese, Alf</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>L6V</scope><scope>M0S</scope><scope>M7S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>7X8</scope></search><sort><creationdate>20170301</creationdate><title>Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis</title><author>Keric, Naureen ; Eum, David J. ; Afghanyar, Feroz ; Rachwal-Czyzewicz, Izabela ; Renovanz, Mirjam ; Conrad, Jens ; Wesp, Dominik M. A. ; Kantelhardt, Sven R. ; Giese, Alf</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-5256003ab7e9ddb3047ba8b16bc9c7fbc38bb11919ffed8cdb388bc1d51750923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abscesses</topic><topic>Accuracy</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antibiotics</topic><topic>Back surgery</topic><topic>Computed tomography</topic><topic>Debridement</topic><topic>Decompression, Surgical - methods</topic><topic>Discitis - diagnostic imaging</topic><topic>Discitis - surgery</topic><topic>Female</topic><topic>Fluoroscopy</topic><topic>Humans</topic><topic>Insertion</topic><topic>Instruments</topic><topic>Intervertebral Disc - diagnostic imaging</topic><topic>Intervertebral Disc - surgery</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgery</topic><topic>Minimally Invasive Surgical Procedures - methods</topic><topic>Original Article</topic><topic>Patients</topic><topic>Pedicle Screws</topic><topic>Radiation dosage</topic><topic>Radiography, Interventional</topic><topic>Retrospective Studies</topic><topic>Robotic surgery</topic><topic>Robotic Surgical Procedures - instrumentation</topic><topic>Robotic Surgical Procedures - methods</topic><topic>Robots</topic><topic>Software</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Tomography, X-Ray Computed</topic><topic>Trauma</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Keric, Naureen</creatorcontrib><creatorcontrib>Eum, David J.</creatorcontrib><creatorcontrib>Afghanyar, Feroz</creatorcontrib><creatorcontrib>Rachwal-Czyzewicz, Izabela</creatorcontrib><creatorcontrib>Renovanz, Mirjam</creatorcontrib><creatorcontrib>Conrad, Jens</creatorcontrib><creatorcontrib>Wesp, Dominik M. A.</creatorcontrib><creatorcontrib>Kantelhardt, Sven R.</creatorcontrib><creatorcontrib>Giese, Alf</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Engineering Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Engineering Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of robotic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keric, Naureen</au><au>Eum, David J.</au><au>Afghanyar, Feroz</au><au>Rachwal-Czyzewicz, Izabela</au><au>Renovanz, Mirjam</au><au>Conrad, Jens</au><au>Wesp, Dominik M. A.</au><au>Kantelhardt, Sven R.</au><au>Giese, Alf</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis</atitle><jtitle>Journal of robotic surgery</jtitle><stitle>J Robotic Surg</stitle><addtitle>J Robot Surg</addtitle><date>2017-03-01</date><risdate>2017</risdate><volume>11</volume><issue>1</issue><spage>17</spage><epage>25</epage><pages>17-25</pages><issn>1863-2483</issn><eissn>1863-2491</eissn><abstract>Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the application of intervertebral cages. In this collective, we compare conventional open to a further minimalized percutaneous robot-assisted spinal instrumentation, avoiding a direct contact of implants and infectious focus. 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments with and without decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. 24 patients were treated by free-hand fluoroscopy-guided surgery (121 screws), and 66 patients were treated by percutaneous robot-assisted spinal instrumentation (341 screws). Accurate screw placement was confirmed in 90 % of robot-assisted and 73.5 % of free-hand placed screws. Implant revision due to misplacement was necessary in 4.95 % of the free-hand group compared to 0.58 % in the robot-assisted group. The average intraoperative X-ray exposure per case was 0.94 ± 1.04 min in the free-hand group vs. 0.4 ± 0.16 min in the percutaneous group (
p
= 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (
p
= 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis.</abstract><cop>London</cop><pub>Springer London</pub><pmid>27277255</pmid><doi>10.1007/s11701-016-0597-5</doi><tpages>9</tpages></addata></record> |
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| subjects | Abscesses Accuracy Adult Aged Aged, 80 and over Antibiotics Back surgery Computed tomography Debridement Decompression, Surgical - methods Discitis - diagnostic imaging Discitis - surgery Female Fluoroscopy Humans Insertion Instruments Intervertebral Disc - diagnostic imaging Intervertebral Disc - surgery Male Medicine Medicine & Public Health Middle Aged Minimally Invasive Surgery Minimally Invasive Surgical Procedures - methods Original Article Patients Pedicle Screws Radiation dosage Radiography, Interventional Retrospective Studies Robotic surgery Robotic Surgical Procedures - instrumentation Robotic Surgical Procedures - methods Robots Software Statistical analysis Surgery Tomography, X-Ray Computed Trauma Urology |
| title | Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis |
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