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10.3171/2021.12.SPINE211176 [doi]
2021.12.SPINE211176 [pii]
Ovid MEDLINE(R)
35120316
Lateral versus prone robot-assisted percutaneous pedicle screw placement: a CT-based comparative assessment of accuracy.
Journal of Neurosurgery Spine. :1-9, 2022 Feb 04
J Neurosurg Spine. :1-9, 2022 Feb 04
Journal of neurosurgery. Spine
2022
FY2022
2022 Feb 04
aheadofprint
2022-02-22
Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: RA-PPSs can improve the feasibility of SP-LLIF. Spine surgeons should be cautious and selective with this technique owing to decreased accuracy in the lateral position, particularly in obese patients. Further studies should compare SP-LLIF techniques performed while the patient is in the prone and lateral positions.
METHODS: The authors reviewed prospectively collected data from their first 100 lateral-position RA-PPSs. The authors graded screw accuracy on CT and compared it to the accuracy of all prone-position RA-PPS procedures during the same time period. The authors analyzed the effect of several demographic and perioperative metrics, as a whole and specifically for lateral-position RA-PPS placement.
OBJECTIVE: Single-position lateral lumbar interbody fusion (SP-LLIF) has recently gained significant popularity due to increased operative efficiency, but it remains technically challenging. Robot-assisted percutaneous pedicle screw (RA-PPS) placement can facilitate screw placement in the lateral position. The authors have reported their initial experience with SP-LLIF with RA-PPS placement in the lateral position, and they have compared this accuracy with that of RA-PPS placement in the prone position.
RESULTS: The authors placed 99 lateral-position RA-PPSs by using the ExcelsiusGPS robotic platform in the first 18 consecutive patients who underwent SP-LLIF with postoperative CT imaging; these patients were compared with 346 prone-position RA-PPSs that were placed in the first consecutive 64 patients during the same time period. All screws were placed at L1 to S1. Overall, the lateral group had 14 breaches (14.1%) and the prone group had 25 breaches (7.2%) (p = 0.032). The lateral group had 5 breaches (5.1%) greater than 2 mm (grade C or worse), and the prone group had 4 (1.2%) (p = 0.015). The operative level had an effect on the breach rate, with breach rates (grade C or worse) of 7.1% at L3 and 2.8% at L4. Most breaches were grade B (< 2 mm) and lateral, and no breach had clinical sequelae or required revision. Within the lateral group, multivariate regression analysis demonstrated that BMI and number of levels affected accuracy, but the side that was positioned up or down did not.
English
IN PROCESS -- NOT YET INDEXED
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
Neurosurgery Residency
Journal Article
Fayed, Islam
Tai, Alexander
Fayed I, Sandhu FA, Sayah A, Tai A, Triano MJ, Voyadzis JM, Weitz D
https://dx.doi.org/10.3171/2021.12.SPINE211176
https://dx.doi.org/10.3171/2021.12.SPINE211176
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authcat
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2022-02-22
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35120316
35120316
2022-02-22
2022-02-22
ART
758
758