Robotic navigation during spine surgery: an update of literature.

INTRODUCTION: The application of robotic navigation during spine surgery has advanced rapidly over the past two decades, especially in the last 5 years. Robotic systems in spine surgery may offer potential advantages for both patients and surgeons. This article serves as an update to our previous review and explores the current status of spine surgery robots in clinical settings. AREAS COVERED: We evaluated the literature published from 2020 to 2022 on the outcomes of robotics-assisted spine surgery, including accuracy and its influencing factors, radiation exposure, and follow-up results. EXPERT OPINION: The application of robotics in spine surgery has driven spine surgery into a new era of precision treatment through a form of artificial intelligence assistance that compensates for the limitations of human abilities. Modularized robot configurations, intelligent alignment and planning incorporating multimodal images, efficient and simple human - machine interaction, accurate surgical status monitoring, and safe control strategies are the main technical features for the development of orthopedic surgical robots. The use of robotics-assisted decompression, osteotomies, and decision-making warrants further study. Future investigations should focus on patients' needs while continuing to explore in-depth medical - industrial collaborative development innovations that improve the overall utilization of artificial intelligence and sophistication in disease treatment.

Prophylactic vertebral augmentation in patients with intra-disc leakage after kyphoplasty.

BACKGROUND: A uperior adjacent vertebral fracture (SAVF) is a common complication after kyphoplasty. Intra-disc leakage is a significant risk factor of SAVF. However, to date, no studies on the prevention of SAVF after intra-disc leakage have been conducted. This study sought to evaluate the clinical outcome of prophylactic vertebral augmentation in high-risk patients, and explore the other risk factors of SAVF. METHODS: Of 2,571 patients who received kyphoplasty, 82 with intra-disc leakage were retrospectively enrolled in the study, and divided into 2 groups based on whether they had a superior level of prophylactic vertebral augmentation. To ensure that any possible early complications were examined, there was a minimum follow-up period of 12 months. RESULTS: The pre-operation parameters were comparable between the 2 groups. In the non-prophylactic group, 9 of 59 (15.3%) patients had SAVF superior to the level of intra-disc leakage. Of these 9 SAVF cases, 8 fractures (88.9%) occurred within 6 months after surgery. Overall, 14 (23.7%) patients developed a new fracture. In the prophylactic group, no patients had a SAVF (0.0%), but 3 (13.0%) had remote fractures (P=0.047 and 0.284). No complications were associated with vertebral augmentation. Further, the risk factor analysis showed that patients with comorbidities and a history of corticoid use had a higher risk of fracture compared with patients with none of these risk factor [odds ratios: 12.0, 95% confidence interval (CI): 1.0-143, and 34.3, 95% CI: 3.2-364.5, respectively]. CONCLUSIONS: Prophylactic vertebral augmentation can prevent SAVF without complications. Patients with comorbidities and a history of corticoid use had a higher risk of SAVF compared with patients without corticoid use. Thus, we recommend prophylactic vertebral augmentation in the selected high-risk patients.

Inserting the Ulnar Prosthesis into Radius as a Novel Salvage Surgery for Revision Total Elbow Arthroplasty with Massive Bone Defect.

BACKGROUND: Infection and aseptic loosening are common complications of total elbow arthroplasty (TEA) and often require revision surgery. However, bone defects, along with other complications, bring an extra difficulty to the second surgery, especially for patients with a massive bone defect in the proximal ulna. Several methods including allograft or autograft have been introduced into practice, but none sufficiently solves these problems. METHODS: We conducted a new surgical method for patients with a massive ulnar bone defect needing revision TEA. During revision arthroplasty, the ulnar prosthesis was inserted into the radius as a salvage procedure. Four consecutive patients received revision arthroplasty with this method between 2013 and 2016. Patients' data were collected to evaluate the clinical outcome. RESULTS: All patients had a Grade III ulnar bone defect. At the last follow-up session, all patients reported a painless, functional elbow joint. Three patients suffered from a periprosthetic infection that was completely cured using the two-stage method. No major complications, including infection, aseptic loosening, or wound problems were found. One patient had a transient ulnar neuritis, and another had a transient radial neuritis. Both patients had full recovery at the last follow-up session. CONCLUSIONS: Inserting an ulnar prosthesis into the radius is a novel procedure for patients with a massive bone defect due to infection or aseptic loosening. It is a safe, quick, and effective treatment with a promising short-term outcome. This method should be provided as a salvage procedure for patients with a nonreconstructable ulnar bone defect.

Plate-only open-door laminoplasty with fusion for treatment of multilevel degenerative cervical disease.

Adequate fixation of the opened laminar arch is the key indicator of a successful laminoplasty surgery; poor outcomes, including secondary narrowing of the spinal canal and a high risk of axial neck pain are possible when using a suturing method during conventional laminoplasty. Rigid fixation including spacers or bone struts yields satisfactory clinical outcomes. However, this approach is also associated with a longer surgical time and an increased risk of instrumentation dislodgement. Plate-only fixation with fusion was developed in our hospital to improve conventional laminoplasty; in addition, the supraspinous ligament is preserved in this procedure. We evaluated both the safety and efficacy of the procedure. Twenty-six patients with multilevel cervical degenerative disease were enrolled for selective open-door laminoplasty with miniplate fixation; autologous bone debris was placed on the hinge side to promote fusion, without bone struts on the open side. The Japanese Orthopedic Association (JOA) score, X-ray, three-dimensional CT scan and MRI were used for the pre- and postoperative evaluations. The mean follow-up period was 22 months (range=12-34 months), and all patients achieved osseous fusion within six months of the operation. Patients who underwent open-door laminoplasty showed an improvement in the JOA score of 60.7%; a 23.0% incidence of axial neck pain and a 3.2° loss of range of motion (ROM) were also observed. No instrumentation failure or clinical deterioration was observed in our study. Thus, open-door laminoplasty with miniplate fixation is a safe, simple surgery for multilevel cervical disease that has significant clinical efficacy. This approach can maintain the cervical ROM, reduce the incidence of postoperative axial neck pain, decrease surgical time and cost, and avoid complications related to fusion.

Vancomycin-loaded nano-hydroxyapatite pellets to treat MRSA-induced chronic osteomyelitis with bone defect in rabbits.

OBJECTIVE: To investigate nano-hydroxyapatite (nHA) pellets as carriers for vancomycin in the treatment of chronic osteomyelitis and bone defects due to methicillin-resistant Staphylococcus aureus (MRSA) strains. METHODS: Chronic osteomyelitis was induced in 45 New Zealand white rabbits. After 3 weeks (chronic infection), all animals were treated with debridement. The rabbits were divided into an experimental group (the bone was filled with vancomycin-loaded nHA pellets), a control group (the bone was filled with nHA pellets alone), and a blank group. The drug release profiles were determined in vitro and in vivo. X-rays, bone specimens, and microorganism cultures were used to evaluate the efficacy of the treatments. RESULTS: Following a rapid initial release into the circulation, the drug concentration remained effective in the osseous and soft tissues for 12 weeks after debridement. Within 3 months, all rabbits in the experimental group recovered from osteomyelitis without a recurrence of the infection and the bone defects were partially repaired, whereas the infection and bone defects persisted in the control and blank groups. CONCLUSIONS: The results demonstrate that vancomycin-loaded nHA pellets successfully repair bone defects and control infection in MRSA-induced chronic osteomyelitis. In addition, nHA is an effective and safe controlled-release vancomycin carrier for chronic osteomyelitis with bone defects that is induced by MRSA.