Predictors of accurate intrapedicular screw placement in single-level lumbar (L4-5) fusion: robot-assisted pedicle screw, traditional pedicle screw, and cortical bone trajectory screw insertion
Abstract Background The superiorities in proximal facet joint protection of robot-assisted (RA) pedicle screw placement and screw implantation via the cortical bone trajectory (CBT) have rarely been compared. Moreover, findings on the screw accuracy of both techniques are inconsistent. Therefore, we...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-07-01
|
| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12893-022-01733-6 |
| _version_ | 1818501815258316800 |
|---|---|
| author | Hua-Qing Zhang Can-Can Wang Ren-Jie Zhang Lu-Ping Zhou Chong-Yu Jia Peng Ge Cai-Liang Shen |
| author_facet | Hua-Qing Zhang Can-Can Wang Ren-Jie Zhang Lu-Ping Zhou Chong-Yu Jia Peng Ge Cai-Liang Shen |
| author_sort | Hua-Qing Zhang |
| collection | DOAJ |
| description | Abstract Background The superiorities in proximal facet joint protection of robot-assisted (RA) pedicle screw placement and screw implantation via the cortical bone trajectory (CBT) have rarely been compared. Moreover, findings on the screw accuracy of both techniques are inconsistent. Therefore, we analyzed the screw accuracy and incidence of facet joint violation (FJV) of RA and CBT screw insertion in the same study and compared them with those of conventional pedicle screw (PS) insertion. The possible factors affecting screw accuracy and FJV were also analyzed. Methods A total of 166 patients with lumbar degenerative diseases requiring posterior L4-5 fusion were retrospectively included and divided into the RA, PS, and CBT groups from March 2019 to December 2021. The grades of intrapedicular accuracy and superior FJV were evaluated according to the Gertzbin–Robbins scale and the Babu scale based on postoperative CT. Univariable and multivariable analyses were conducted to assess the possible risk factors associated with intrapedicular accuracy and superior FJV. Results The rates of optimal screw insertion in the RA, PS, and CBT groups were 87.3%, 81.3%, and 76.5%, respectively. The difference between the RA and CBT groups was statistically significant (P = 0.004). Superior FJVs occurred in 28.2% of screws in RA, 45.0% in PS, and 21.6% in CBT. The RA and CBT groups had fewer superior FJVs than the PS group (P = 0.008 and P < 0.001, respectively), and no significant difference was observed between the RA and CBT groups (P = 0.267). Multivariable analysis revealed that the CBT technique was an independent risk factor for intrapedicular accuracy. Furthermore, older age, the conventional PS technique and a smaller facet angle were independently associated with the incidence of superior FJVs. Conclusions The RA and CBT techniques were associated with fewer proximal FJVs than the PS technique. The RA technique showed a higher rate of intrapedicular accuracy than the CBT technique. The CBT technique was independently associated with screw inaccuracy. Older age, conventional PS technique and coronal orientation of the facet join were independent risk factors for superior FJV. |
| first_indexed | 2024-12-10T21:01:25Z |
| format | Article |
| id | doaj.art-32cc8c1c3d6f4037a2079627d47dbb18 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-10T21:01:25Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-32cc8c1c3d6f4037a2079627d47dbb182022-12-22T01:33:47ZengBMCBMC Surgery1471-24822022-07-0122111010.1186/s12893-022-01733-6Predictors of accurate intrapedicular screw placement in single-level lumbar (L4-5) fusion: robot-assisted pedicle screw, traditional pedicle screw, and cortical bone trajectory screw insertionHua-Qing Zhang0Can-Can Wang1Ren-Jie Zhang2Lu-Ping Zhou3Chong-Yu Jia4Peng Ge5Cai-Liang Shen6Department of Orthopedics, Spine Surgery, The First Affiliated Hospital of Anhui Medical UniversityDepartment of Orthopedics, Spine Surgery, The First Affiliated Hospital of Anhui Medical UniversityDepartment of Orthopedics, Spine Surgery, The First Affiliated Hospital of Anhui Medical UniversityDepartment of Orthopedics, Spine Surgery, The First Affiliated Hospital of Anhui Medical UniversityDepartment of Orthopedics, Spine Surgery, The First Affiliated Hospital of Anhui Medical UniversityDepartment of Orthopedics, Spine Surgery, The First Affiliated Hospital of Anhui Medical UniversityDepartment of Orthopedics, Spine Surgery, The First Affiliated Hospital of Anhui Medical UniversityAbstract Background The superiorities in proximal facet joint protection of robot-assisted (RA) pedicle screw placement and screw implantation via the cortical bone trajectory (CBT) have rarely been compared. Moreover, findings on the screw accuracy of both techniques are inconsistent. Therefore, we analyzed the screw accuracy and incidence of facet joint violation (FJV) of RA and CBT screw insertion in the same study and compared them with those of conventional pedicle screw (PS) insertion. The possible factors affecting screw accuracy and FJV were also analyzed. Methods A total of 166 patients with lumbar degenerative diseases requiring posterior L4-5 fusion were retrospectively included and divided into the RA, PS, and CBT groups from March 2019 to December 2021. The grades of intrapedicular accuracy and superior FJV were evaluated according to the Gertzbin–Robbins scale and the Babu scale based on postoperative CT. Univariable and multivariable analyses were conducted to assess the possible risk factors associated with intrapedicular accuracy and superior FJV. Results The rates of optimal screw insertion in the RA, PS, and CBT groups were 87.3%, 81.3%, and 76.5%, respectively. The difference between the RA and CBT groups was statistically significant (P = 0.004). Superior FJVs occurred in 28.2% of screws in RA, 45.0% in PS, and 21.6% in CBT. The RA and CBT groups had fewer superior FJVs than the PS group (P = 0.008 and P < 0.001, respectively), and no significant difference was observed between the RA and CBT groups (P = 0.267). Multivariable analysis revealed that the CBT technique was an independent risk factor for intrapedicular accuracy. Furthermore, older age, the conventional PS technique and a smaller facet angle were independently associated with the incidence of superior FJVs. Conclusions The RA and CBT techniques were associated with fewer proximal FJVs than the PS technique. The RA technique showed a higher rate of intrapedicular accuracy than the CBT technique. The CBT technique was independently associated with screw inaccuracy. Older age, conventional PS technique and coronal orientation of the facet join were independent risk factors for superior FJV.https://doi.org/10.1186/s12893-022-01733-6Proximal facet joint violationMinimally invasive surgeryCortical bone trajectoryRobotic‐assisted pedicle screwTraditional pedicle screwScrew accuracy |
| spellingShingle | Hua-Qing Zhang Can-Can Wang Ren-Jie Zhang Lu-Ping Zhou Chong-Yu Jia Peng Ge Cai-Liang Shen Predictors of accurate intrapedicular screw placement in single-level lumbar (L4-5) fusion: robot-assisted pedicle screw, traditional pedicle screw, and cortical bone trajectory screw insertion BMC Surgery Proximal facet joint violation Minimally invasive surgery Cortical bone trajectory Robotic‐assisted pedicle screw Traditional pedicle screw Screw accuracy |
| title | Predictors of accurate intrapedicular screw placement in single-level lumbar (L4-5) fusion: robot-assisted pedicle screw, traditional pedicle screw, and cortical bone trajectory screw insertion |
| title_full | Predictors of accurate intrapedicular screw placement in single-level lumbar (L4-5) fusion: robot-assisted pedicle screw, traditional pedicle screw, and cortical bone trajectory screw insertion |
| title_fullStr | Predictors of accurate intrapedicular screw placement in single-level lumbar (L4-5) fusion: robot-assisted pedicle screw, traditional pedicle screw, and cortical bone trajectory screw insertion |
| title_full_unstemmed | Predictors of accurate intrapedicular screw placement in single-level lumbar (L4-5) fusion: robot-assisted pedicle screw, traditional pedicle screw, and cortical bone trajectory screw insertion |
| title_short | Predictors of accurate intrapedicular screw placement in single-level lumbar (L4-5) fusion: robot-assisted pedicle screw, traditional pedicle screw, and cortical bone trajectory screw insertion |
| title_sort | predictors of accurate intrapedicular screw placement in single level lumbar l4 5 fusion robot assisted pedicle screw traditional pedicle screw and cortical bone trajectory screw insertion |
| topic | Proximal facet joint violation Minimally invasive surgery Cortical bone trajectory Robotic‐assisted pedicle screw Traditional pedicle screw Screw accuracy |
| url | https://doi.org/10.1186/s12893-022-01733-6 |
| work_keys_str_mv | AT huaqingzhang predictorsofaccurateintrapedicularscrewplacementinsinglelevellumbarl45fusionrobotassistedpediclescrewtraditionalpediclescrewandcorticalbonetrajectoryscrewinsertion AT cancanwang predictorsofaccurateintrapedicularscrewplacementinsinglelevellumbarl45fusionrobotassistedpediclescrewtraditionalpediclescrewandcorticalbonetrajectoryscrewinsertion AT renjiezhang predictorsofaccurateintrapedicularscrewplacementinsinglelevellumbarl45fusionrobotassistedpediclescrewtraditionalpediclescrewandcorticalbonetrajectoryscrewinsertion AT lupingzhou predictorsofaccurateintrapedicularscrewplacementinsinglelevellumbarl45fusionrobotassistedpediclescrewtraditionalpediclescrewandcorticalbonetrajectoryscrewinsertion AT chongyujia predictorsofaccurateintrapedicularscrewplacementinsinglelevellumbarl45fusionrobotassistedpediclescrewtraditionalpediclescrewandcorticalbonetrajectoryscrewinsertion AT pengge predictorsofaccurateintrapedicularscrewplacementinsinglelevellumbarl45fusionrobotassistedpediclescrewtraditionalpediclescrewandcorticalbonetrajectoryscrewinsertion AT cailiangshen predictorsofaccurateintrapedicularscrewplacementinsinglelevellumbarl45fusionrobotassistedpediclescrewtraditionalpediclescrewandcorticalbonetrajectoryscrewinsertion |