Article
Experience of 4 years robotic-guided spinal instrumentation in the treatment of spondylolisthesis vera
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Authors
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Andreas Kramer
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany
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Naureen Keric
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany
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Alf Giese
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany
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Sven R. Kantelhardt
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Presence of a spinal deformity such as spondylolysis is often considered as a contraindication for percutaneous transpedicular instrumentation. This is mainly because it is frequently associated with hypoplastic pedicles and other abnormalities of the affedted vertebral segment which alter the radiographic appearance of common landmarks used for fluorescence-guided pedicle screw insertion. We report here on 4 years of clinical experience in robotic-guided percutaneous pedicle screw insertion in spondylolisthesis vera patients.
Method: Medical records and CT-data of 41 consecutive patients from October 2011 until September 2015 with lumbar spondylolysis undergoing pedicle screw placement were analyzed. Accuracy of pedicle screws, intra- and postoperative complication and revision rates were evaluated.
Results: A total of 41 patients with symptomatic lumbar spondylolisthesis vera (19 male, 22 female, age: 26 - 76 years) received 172 robot-assisted pedicle screws in the period from October 2011 to September 2015 in our department. With one exception (instability of adjacent segment with pre-existing spondylodesis), in which 4 of 8 screws were placed according to the conventional open technique, the remaining pedicle screws (97,7%) could be placed with robotic guidance with high registration precision. Accuracy of screw position was evaluated according to Wiesner et al., resulting in correct screw positioning in 98.8% and misplacement in 1.2% of pedicle screws. Intraoperative complications occurred in 1 case (2.4 %, dural tear, which occurred however during cage-placement). Adverse events during the postoperative course consisted mainly of persistent pain syndromes requiring further therapy (sacroiliac joint syndrome in 12%, L5-radiculopathy in 4.8%). In a total of 4 cases (9.8%) revision surgery was necessary (two cases, resp. 4.9% of wound-healing disorders and implant revisions each – one of the latter cases developed a L5 fracture with consecutive dislocation of screws and in another case a screw had to be exchanged for a shorter screw, as it protruded from the L5 vertebrae.
Conclusions: Percutaneous robotic-guided placement of pedicle screws is a feasible and safe alternative to conventional open approaches for instrumentation of spondylolisthesis vera patients. Screw accuracy rate was 97.7% in 41 cases.
