gms | German Medical Science

Objective: Robot-assisted percutaneous insertion of pedicle screws is a recently introduced promising technology. The best surgical treatment in spondylodiscitis is still a matter of debate. However, use of surgical treatment with decompression, evacuation of abscess formations and spinal fusion in spondlyodiscitis is increasing. We performed a retrospective cohort study, which compares conventional open spinal fusion to minimally invasive percutaneous robot-assisted spondylodesis with or without minimal access decompression of intraspinal abscess.

Method: 44 patient records and CT scans were analysed for the clinical and radiological parameters. 24 patients underwent conventional open spinal fusion (122 screws) and 20 patients underwent percutaneous robot-assisted spondylodesis (100 screws) with minimally invasive microsurgical decompression and debridement. Accuracy of screw positioning, X-ray exposure, intra- and postoperative course and complications, duration of hospitalization were also collected.

Results: 37.5% (6 patients) of the free-hand group and 10 % (2 patients) of the percutaneous group showed wound healing deficits. Screw misplacement corresponding to grade 3 and 4 or screw loosening occurred in 4.92 % (6 screws) of the free-hand group requiring implant revision, whereas in the percutaneous group 1% (1screw) of implants required revision. 97.9% of robot-assisted screws in percutaneous and 87.7 % of conventional pedicle screw placement were found to be accurate. The average intraoperative X-Ray exposure was 4.9 ± 5.2 minutes in the free-hand group compared to 1.7 ± 1.6 minutes in the percutaneous group (p=0.009). Intraoperative adverse events (2 major hemorrhage, 3 dural tears) were observed in 20,8 % of conventional group and 5% (1 dural tear) of robot group. The mean postoperative hospital stay in the free-hand group was 18.1 ± 13 days and in percutaneous group, 13.4 ± 6 days (p=0.012).

Conclusions: This study demonstrates that minimally invasive percutaneous robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, decreased complication rates, less complicated perioperative course and with a shorter postoperative hospital stay. It can be expected that the advantages of minimally invasive spinal fusion with or without navigation will eventually shift treatment strategies towards surgical treatment and may allow treatment of patients in severely critical conditions.