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PURPOSE: The purpose of this study was to clarify the learning curve for robotic-assisted spine surgery. We analyzed the workflow in robotic-assisted spine surgery and investigated how much experience is required to become proficient in robotic-assisted spine surgery. METHODS: The data were obtained from consecutive 125 patients who underwent robotic-assisted screw placement soon after introducing a spine robotic system at a single center from April 2021 to January 2023. The 125 cases were divided into phases 1-5 of sequential groups of 25 cases each and compared for screw insertion time, robot setting time, registration time, and fluoroscopy time. RESULTS: There were no significant differences in age, body mass index, intraoperative blood loss, number of fused segments, operation time, or operation time per segment between the 5 phases. There were significant differences in screw insertion time, robot setting time, registration time, and fluoroscopy time between the 5 phases. The screw insertion time, robot setting time, registration time, and fluoroscopy time in phase 1 were significantly longer than those in phases 2, 3, 4, and 5. CONCLUSION: In an analysis of 125 cases after the introduction of the spine robotic system, the screw insertion time, robot setting time, registration time, and fluoroscopy time were significantly longer in the 25 cases in the period initially after introduction. The times were not significantly different in the subsequent 100 cases. Surgeons can be proficient in robotic-assisted spine surgery after their experience with 25 cases.
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Parafusos Pediculares , Procedimentos Cirúrgicos Robóticos , Robótica , Fusão Vertebral , Humanos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Curva de Aprendizado , Parafusos Ósseos , Fluoroscopia , Estudos RetrospectivosRESUMO
PURPOSE: To investigate longitudinal changes in bone mineral density (BMD) in middle-aged female patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS). METHODS: The study subjects were 229 female patients who were diagnosed with AIS and underwent spinal fusion between 1968 and 1988. A two-step survey study was conducted on 19 female AIS patients. BMD, Z-scores, T-scores, and the prevalence of osteoporosis and osteopenia were compared between the initial (2014-2016) and second (2022) surveys. Correlations between the annual changes in Z-scores and T-scores with radiographic parameters, body mass index (BMI), and the number of remaining mobile discs were analyzed. RESULTS: BMD decreased significantly from the initial (0.802 ± 0.120 g/cm2) to the second survey (0.631 ± 0.101 g/cm2; p < 0.001). Z-scores decreased from 0.12 ± 1.09 to - 0.14 ± 1.04, while T-scores decreased significantly from - 0.70 ± 1.07 to - 1.77 ± 1.11 (p < 0.001). The prevalence of osteopenia and osteoporosis increased significantly from 36.8% to 89.5% (p = 0.002), but the increase in osteoporosis alone was not statistically significant (5.3% to 26.3%; p = 0.180). Moderate negative correlations were found between annual changes in Z-scores and both main thoracic (MT) curve (r = - 0.539; p = 0.017) and lumbar curve (r = - 0.410; p = 0.081). The annual change in T-scores showed a moderate negative correlation with the MT curve (r = - 0.411; p = 0.081). CONCLUSION: Significant reductions in BMD and an increased prevalence of osteopenia and osteoporosis were observed in middle-aged female AIS patients who had undergone spinal fusion. The decline in Z-scores in patients with AIS suggested that there was an accelerated loss of BMD compared with the general population. Larger residual curves could pose an added osteoporosis risk. Further research is needed to understand if the onset of osteoporosis in AIS patients is attributable to the condition itself or the surgical intervention.
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Doenças Ósseas Metabólicas , Cifose , Osteoporose , Escoliose , Pessoa de Meia-Idade , Humanos , Feminino , Adolescente , Densidade Óssea , Escoliose/epidemiologia , Escoliose/cirurgia , Seguimentos , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/etiologia , Osteoporose/epidemiologia , Osteoporose/etiologiaRESUMO
PURPOSE: To compare the accuracy of pedicle screw placement in adolescent idiopathic scoliosis (AIS) between robotics and navigation and clarify the factors that cause screw deviation when robotics is used. METHODS: Fifty consecutive patients who underwent posterior spinal fusions with computer-assisted pedicle screw placement including robotics and navigation for AIS were included. A total of 741 pedicle screws (250: Robot group, 491: Navi group) were evaluated on postoperative CT images. A rate of penetration of ≥ 2 mm was calculated as the deviation rate. After propensity score matching, we examined vertebral levels, the distance from the reference frame (RF), and the pedicle channel grade as factors for deviation. RESULTS: The deviation rate was significantly lower in the Robot group than in the Navi group (Robot group: 1.6%, Navi group: 7.5%). After propensity score matching, 22 cases were extracted. At T5-T8, the deviation rate of the Robot group was significantly lower than that of the Navi group. In the Robot group, the T2-T4 deviation rate was significantly higher than at the other vertebral levels. The distance from the RF didn't affect the deviation rate. The deviation rate of pedicle channel Grade 4 (inner diameter of less than 1 mm) was significantly higher than for the other grades. CONCLUSION: The deviation rate of robotics was 1.6%, lower than that of navigation. The narrow pedicles with an inner diameter of less than 1 mm (deviation rate: 22.2%) and the upper thoracic level (deviation rate: 14.3%) were factors related to screw deviation even when using robotics.
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Parafusos Pediculares , Robótica , Escoliose , Fusão Vertebral , Cirurgia Assistida por Computador , Humanos , Adolescente , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Cirurgia Assistida por Computador/métodos , Fusão Vertebral/métodos , Computadores , Estudos RetrospectivosRESUMO
BACKGROUND: The purpose of this study was to verify whether a spine robotic system was useful for junior surgeons. METHODS: Twenty-seven patients underwent posterior spinal fusion with open surgery using a spine robotic system (Mazor X Stealth Edition, Medtronic Inc., Dublin, Ireland) from April to August 2021. Pedicle screw insertions were performed by five surgeons. The surgeon and insertion time were recorded for each pedicle screw. Two surgeons who are board-certified spine surgeons by the Japanese Society for Spine Surgery and Related Research (JSSR) were defined as the expert surgeon group. Three surgeons who were training to acquire qualifications as JSSR board certified spine surgeons were defined as the junior surgeon group. In postoperative CT images, the deviation of 255 pedicle screws was evaluated using the Gertzbein-Robbins (GR) grades. RESULTS: In the expert surgeon group, the GR grades were Grade A for 79 screws (90.8%), Grade B for 6 (6.9%), Grade C for 2 (2.3%), and 0 (0%) for Grades D and E. I In the junior surgeon group, the GR grades were Grade A for 162 screws (96.4%), Grade B for 6 (3.6%), and 0 (0%) for Grades C, D, and E. There was no significant difference in the deviation rate between surgeon groups (p = 0.08). The mean insertion times were 174.5 ± 83.0 s in the expert surgeon group and 191.0 ± 111.0 s in the junior surgeon group. There was no significant difference in the insertion time between surgeon groups (p = 0.22). CONCLUSIONS: There were no significant differences in the deviation rate and the insertion time of robotic-assisted pedicle screw placement between expert surgeons and junior surgeons who were training to acquire qualifications as JSSR board certified spine surgeons. Robotic-assisted pedicle screw placement can be effectively employed by junior surgeons.
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Parafusos Pediculares , Procedimentos Cirúrgicos Robóticos , Fusão Vertebral , Cirurgiões , Cirurgia Assistida por Computador , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/métodos , Fusão Vertebral/métodosRESUMO
BACKGROUND: The present study aimed to evaluate the safety of robot-assisted screw placement in 125 cases after introducing a spinal robotics system and to identify the situations where deviation was likely to occur. METHODS: The subjects were 125 consecutive patients who underwent robotic-assisted screw placement using a spinal robotics system (Mazor X Stealth Edition, Medtronic) from April 2021 to January 2023. The 1048 screws placed with robotic assistance were evaluated. We investigated intraoperative adverse events of the robotics system and complications occurring within 30 days after surgery. We evaluated screw accuracy and deviation and compared them for vertebral levels, screw insertion methods (open traditional pedicle screw [Open-PS], cortical bone trajectory screw [CBT], percutaneous pedicle screw [PPS], and S2 alar iliac screw [S2AIS]), diagnosis, and phases of surgical cases. RESULTS: The deviation rate of robotic-assisted screw placement for spine surgery was 2.2%. Complications were reoperation due to implant-related neurological deficit in 0.8% and surgical site infection in 0.8%. There was significant difference in the deviation rate between vertebral levels. The deviation rate of the T1-T4 level was high at 10.0%. There was significant difference in the deviation rate between Open-PS, CBT, PPS, and S2AIS. The PPSs had a high deviation rate of 10.3%. The deviation rates were not significantly different between patients with and without deformity. The deviation rate did not change depending on the experience of surgical cases, and the deviation rate was favorable from the onset. CONCLUSION: Although the robotic-assisted screw placement was safe, we should be extra vigilant when placing screws in the upper thoracic region (deviation rate 10.0%) and when using PPSs (deviation rate 10.3%).
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PURPOSE: To verify whether robotics was useful for surgeons who had less experience with spinal deformity surgery. METHODS: A retrospective review was conducted of 70 consecutive patients who underwent robotic-assisted pedicle screw placements with open procedures using a spine robotic system (Mazor X Stealth Edition) at a single institution from April 2021 to April 2022. Gertzbein-Robbins grades were used to assess the deviation of the 599 pedicle screws in the postoperative CT images. The rate of Grade A was considered the perfect accuracy rate, and the rate of Grades C, D, and E was calculated as the deviation rate. The perfect accuracy rate and deviation rate were compared between the spinal deformity and the non-deformity groups. The perfect accuracy rate, deviation rate, and screw insertion time were compared in the spinal deformity cases between the expert surgeon group and the less-experienced surgeon group. RESULTS: The deviation rate of the spinal deformity group was higher than that of the non-deformity group even though there was no statistically significant difference (spinal deformity group: 2.3%, non-deformity group: 1.2%, p = 0.350). In the spinal deformity cases, there was no significant difference in the perfect accuracy rate between the expert surgeon group and the less-experienced surgeon group, but the deviation rate was significantly lower in the less-experienced surgeon group (expert surgeon group: 5.0%, less-experienced surgeon group: 0%, p = 0.008). The screw insertion time was significantly shorter in the less-experienced surgeon group. CONCLUSION: Robotics is particularly useful for surgeons with less experience in spinal deformity surgery.
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Parafusos Pediculares , Procedimentos Cirúrgicos Robóticos , Robótica , Fusão Vertebral , Cirurgiões , Cirurgia Assistida por Computador , Humanos , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/métodos , Estudos Retrospectivos , Fusão Vertebral/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Vértebras Lombares/cirurgiaRESUMO
BACKGROUND: Despite the identification of various risk factors for pancreatitis and hyperamylasemia following spinal surgery, no report has investigated the relationship between spinal alignment changes and elevated serum amylase levels. The purpose of this study was to investigate the relationship between spinal alignment changes and hyperamylasemia after spinal fusion. METHODS: A total of 222 patients whose serum pancreatic amylase levels were measured before and after spinal surgery from December 2017 to May 2019 were included. Inclusion criteria were (1) spinal fusion including the thoracolumbar junction (T10-L2) and (2) serum pancreatic amylase measurements before, immediately after surgery (day 0), the day after surgery (day 1), and 1 week after surgery. Ultimately, 37 patients who met the criteria were analyzed. Patients with hyperamylasemia at day 0 and/or day 1 (H group) were then compared with those without hyperamylasemia (N group). RESULTS: No significant differences in age, sex, surgical procedure, number of fused segments, intraoperative blood loss, operative time or American Society of Anesthesiologists physical status classification were observed between both groups. The H group had significantly larger preoperative thoracolumbar kyphosis (TLK) (H group: 22.6°, N group: 6.4°), postoperative TLK (H group: 16.8°, N group: 7.6°), and preoperative T12-L1 kyphosis angles (H group: 16.2°, N group: 7.9°) compared with the N group. Moreover, the H group demonstrated a significant decrease in TLK after surgery (H group: -5.8°, N group: 1.6°). CONCLUSIONS: Risk factors for hyperamylasemia included a large preoperative TLK angle and a greater postoperative decrease in TLK. Thus, decreased TLK after spinal fusion surgery should prompt careful attention to abdominal symptoms and elevated pancreatic amylase levels.
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Cifose , Pancreatite , Fusão Vertebral , Doença Aguda , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Pancreatite/etiologia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Coluna Vertebral , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgiaRESUMO
PURPOSE: To clarify the impact of anchor type at upper instrumented vertebra (UIV) on postoperative shoulder imbalance in patients with Lenke type 1 adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion. METHODS: Subjects were 81 patients with Lenke type 1 AIS who underwent posterior spinal fusion between 2004 and 2013. Twenty-five patients agreed to participate in the study. We divided the patients into two groups: Hook group (15 patients with hooks at UIV who underwent surgery between 2004 and 2011) and PS group (ten patients with pedicle screws at UIV who underwent surgery between 2012 and 2013). To evaluate shoulder balance, first thoracic vertebra tilt angle (T1 tilt), clavicle angle (CA), and radiographic shoulder height (RSH) were measured. RESULTS: There were no significant differences in preoperative T1 tilt, CA, or RSH between the both groups. The postoperative 1-week, 2-year, and most recently observed T1 tilts were significantly smaller in the Hook group than in the PS group. There were no significant differences in postoperative 1-week, 2-year, and most recently observed CAs between the two groups. Although there were no significant differences in 1-week postoperative RSH between the groups, the 2-year postoperative RSH was significantly smaller in the Hook group than in the PS group. The most recently observed RSH tended to be smaller in the Hook group than in the PS group, but the difference was not significant. CONCLUSIONS: In the PS group, poor shoulder balance remained over the long term. The hooks at UIV adjusted postoperative shoulder balance.
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Escoliose , Fusão Vertebral , Adolescente , Seguimentos , Humanos , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Ombro/diagnóstico por imagem , Ombro/cirurgia , Fusão Vertebral/efeitos adversos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgiaRESUMO
BACKGROUND: To investigate dural sac enlargements and spinal alignments in patients who underwent indirect decompression with interspinous spacers. METHODS: The subjects were 20 patients who underwent indirect decompression using an interspinous spacer (X-STOP) without laminectomy. Of these 20 patients, 1 patient underwent implant removal surgery 1 month after X-STOP surgery and two patients dropped out. Ultimately, 17 patients were included in this study. MRI and X-ray images were investigated before surgery, 1 week after surgery, 3 months after surgery, and 2 years after surgery. RESULTS: On MRI, the mean cross-sectional areas of the dural sac were 52.7 mm2 before surgery, 73.2 mm2 1 week after surgery, 62.4 mm2 3 months after surgery, and 58.3 mm2 2 years after surgery. There was a significant 37% increase at 1 week postoperatively compared with that before surgery, but there were no significant differences between 3 months postoperatively and 2 years postoperatively. The disc angle in an extension posture was significantly decreased at 1 week after surgery compared with that before surgery, but there were no significant differences between before surgery, 3 months after surgery, and 2 years after surgery. CONCLUSIONS: The interspinous process spacer increased the dural sac area by 37% 1 week after surgery, but the enlargement was not maintained at 3 months or 2 years after surgery. The use of interspinous process spacers produced an enlargement of the dural sac by limiting extension of the stenotic level only. However, its effect diminished 2 years after surgery.
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Descompressão Cirúrgica/efeitos adversos , Dura-Máter/patologia , Próteses e Implantes/efeitos adversos , Estenose Espinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Dura-Máter/diagnóstico por imagem , Feminino , Humanos , Hipertrofia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estenose Espinal/diagnóstico por imagemRESUMO
BACKGROUND: The aim of this study was to conduct an investigation into spinal fusion with Harrington instrument (HI) in patients with adolescent idiopathic scoliosis (AIS) and to survey pulmonary function and thoracic deformity outcomes many years after surgery. METHODS: Subjects comprised 194 patients diagnosed with AIS and treated with spinal fusion using HI between 1968 and 1987. Patients who gave their informed consent were subjected to a complete standing spine X-ray, chest CT, and pulmonary function tests. Eighteen patients were eligible for inclusion. Mean age at the time of follow-up was 49.9 years and the mean duration of follow-up was 35.3 years. CT axial image was used at the apex of the main thoracic curve. Apical vertebral rotation was determined from RA sag measured by the method of Aaro et al. Thoracic cage deformities were measured as follows: Rib hump index (RHi) according to the method of Aaro et al. and posterior hemithoracic symmetry ratio (PHSr) according to the method of Campbell et al. RESULTS: Pulmonary function tests revealed mean forced vital capacity (FVC) of 2.28 (range: 1.00-3.04) L and mean %FVC of 83.5% (range: 35.6%-117.8%). Restrictive ventilation disorder with %FVC <80% was seen in 5 patients (27.7%). %FVC had strong negative correlations with RA sag (r = -0.798), RHi (r = -0.820, p < 0.001), PHSr (r = -0.705), and proximal thoracic curve (r = -0.721). Main thoracic curve (r = -0.674) and apical vertebral rotation of thoracic curve (r = -0.685) showed moderate negative correlations. Multiple regression analysis revealed RHi was a most significant factor on %FVC. CONCLUSIONS: In AIS patients examined 27 years or longer after surgery, restrictive ventilation defects were observed in 27.7%. Factors aggravating %FVC were large rib humps and large vertebral rotations. Three-dimensional correction of the spine and thoracic cage deformities is vital in order to avoid pulmonary function impairment many years after surgery.
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Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Fatores Etários , Distribuição de Qui-Quadrado , Criança , Estudos de Coortes , Feminino , Seguimentos , Humanos , Fixadores Internos , Japão , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Estudos Retrospectivos , Índice de Gravidade de Doença , Fusão Vertebral/métodos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Our previous study reported a good health-related quality of life (HRQOL) in adolescent idiopathic scoliosis (AIS) patients 21 years or more after surgery. The purpose of this study is to investigate midlife changes in HRQOL among AIS patients who passed further 5 years from the previous survey. METHODS: Subjects were 252 individuals who underwent spinal fusion for AIS between 1968 and 1988. The survey was administered twice-in 2009 and in 2014 using Scoliosis Research Society Patient Questionnaire (SRS-22). We analysed survey responses from 42 individuals (39 females, 3 males) who responded to both surveys. RESULTS: The average scores for each respective domain of the SRS-22 in 2009 and 2014, respectively, were: function, 4.3 and 4.2; pain, 4.3 and 4.3; self-image, 3.0 and 2.9; mental, 3.9 and 3.8; satisfaction, 3.6 and 3.5. There were no significant differences in any domain of the SRS-22 between 2009 and 2014. Comparing non-fused segments of the lumbar spine of patients with fewer than four discs remaining with patients with four discs or more remaining, SRS-22 satisfaction score decreased more in patients with fewer than four discs (change in patients with four discs or more: -0.02; change in patients with fewer than four discs: -0.38; P = 0.05). CONCLUSION: Each SRS-22 subscore was similar between 2009 and 2014 surveys. Those scoliosis patients who underwent spinal fusion during adolescence had good HRQOL scores in midlife. Even after five years passed, good conditions were maintained.
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Qualidade de Vida , Escoliose/complicações , Escoliose/psicologia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Dor/etiologia , Satisfação Pessoal , Escoliose/fisiopatologia , Escoliose/cirurgia , Autoimagem , Fusão VertebralRESUMO
Purpose To elucidate the utility of a navigated high-speed drill used after the version upgrade in surgeries assisted by a spinal robotics system. Methods The subjects were 166 patients who underwent screw placement using a spinal robotics system between April 2021 to July 2023. A significant change during the study was the introduction of a navigated high-speed drill in 80 post-upgrade cases, aimed at improving drilling accuracy. Screw accuracy was analyzed using the Gertzbein and Robbins classification on postoperative CT scans. Screws placed before (pre-upgrade group: 718 screws in 86 cases) and after the system upgrade (post-upgrade group: 747 screws in 80 cases) were compared in terms of perfect accuracy and deviation rates. Results There were no significant differences in demographics or surgical details between the two groups. No significant differences were observed in the overall perfect accuracy rate and deviation rate (2.4% pre-upgrade vs. 2.0% post-upgrade) between the two groups. For the percutaneous pedicle screw (PPS), the perfect accuracy rate was significantly higher, and the deviation rate was significantly lower in the post-upgrade group (26.1% pre-upgrade vs. 4.4% post-upgrade). Notably, the post-upgrade group achieved 100% perfect accuracy and 0% deviation for the cortical bone trajectory screw (CBT) technique. Conclusions The introduction of the navigated high-speed drill did not significantly alter the overall perfect accuracy or deviation rates for robotic-assisted screw placement. However, its use did demonstrate improved outcomes in specific techniques such as PPS and CBT, indicating its potential value in addressing skiving in robotic-assisted minimally invasive surgeries.
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Purpose To investigate the impact of the COVID-19 pandemic on middle-aged and older patients with adolescent idiopathic scoliosis (AIS) who underwent spinal fusion. Methods The subjects were 252 AIS patients who underwent spinal fusion between 1968 and 1988. The surveys were performed before the COVID-19 pandemic (a primary survey in 2014) and during the pandemic (a secondary survey in 2022). The self-administered questionnaires were mailed to the patients. We analyzed 35 patients (33 females and two males) who replied to both surveys. Results The pandemic had low impacts on 11 patients (31.4%). Two patients reported refraining from seeing a doctor because they were concerned about going to the clinic or hospital, eight reported that the pandemic impacted their work, and five reported fewer opportunities to go out (based on multiple-choice answers). Twenty-four patients reported that their lives were unaffected by the pandemic. No significant differences were detected between both surveys for Scoliosis Research Society-22 (SRS-22) in any domains (function, pain, self-image, mental, or satisfaction). The Oswestry Disability Index (ODI) questionnaires revealed a significant worsening of the survey during the pandemic compared with the survey before the pandemic. There was no significant difference in the impact of the pandemic between the ODI deterioration group (27.8%) and the ODI stable group (35.3%). Conclusion The COVID-19 pandemic had a low impact on 31.4% of middle-aged and older patients with AIS who underwent spinal fusion. The impact of the pandemic did not significantly differ between the groups with ODI deteriorations and the groups with stable ODI. The pandemic had a smaller impact on AIS patients at a minimum of 33 years after surgery.
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Background Preoperative and postoperative nutritional statuses are reported to influence the outcomes and complications of multidisciplinary treatment, including patient survival. However, a causal relationship between nutritional status and survival following spinal surgery has not been demonstrated in patients with metastatic spinal tumors. The present study was, therefore, designed to evaluate the correlation between the nutritional status and survival following spinal surgery in patients with metastatic spinal tumors. Methods Nutritional status was evaluated using the Japanese version of the modified Glasgow prognostic score (JmGPS), C-reactive protein-to-albumin ratio (CAR), prognostic nutrition index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), which were calculated from the results of preoperative laboratory tests. The survival period was defined as the interval between the day preoperative data were obtained and the day of death. Results Data from 57 of 113 consecutive surgeries were retrieved. The CAR, JmGPS, and PNI were significantly correlated with the survival period (CAR, r = -0.576, P < 0.01; JmGPS, r = -0.537, P < 0.01; PNI, r = 0.316, P = 0.02). Furthermore, patients with 0 points on the JmGPS had significantly longer survival. Using receiver operating characteristic curves, CAR cutoffs of ≥0.880 and ≤0.220 were found to be optimal in predicting the 90- and 180-day postoperative survival, respectively. Conclusions The findings of the present study indicate that preoperative assessment of the JmGPS, CAR, and PNI has utility in estimating nutritional status and predicting survival following spinal surgery in patients with metastatic spinal tumors.
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Purpose This study aimed to compare the radiographic and patient-reported outcomes after surgery in adolescent idiopathic scoliosis (AIS) between robotics and navigation using propensity score matching. Methods This retrospective study involved 50 patients undergoing posterior spinal fusion for AIS between October 2016 and August 2022, utilizing navigation or robotic systems, analyzing them using propensity score matching. The evaluations included assessments using X-ray, Scoliosis Research Society 22-Item (SRS-22) Questionnaire, and CT, considering variables such as age, gender, BMI, and Lenke type. Results Post matching, 13 cases each from robotics and navigation groups were compared. No significant differences were found in the demographic variables, preoperative X-ray parameters, and preoperative SRS-22 scores between the two groups. The robotics group demonstrated a higher perfect accuracy rate (94.0% vs. 84.7%, p=0.005) and a lower deviation rate in pedicle screw placements (1.6% vs. 4.1%, p=0.223). At one year postoperatively, there were no significant differences in the X-ray parameters between both groups. Likewise, no significant differences were found in each domain of SRS-22, but function, self-image, mental health, and satisfaction scores were numerically higher in the robotics group. Conclusion The application of a spinal robotic system in AIS surgery presented enhanced screw accuracy and lower deviation rates, compared to navigation, with no significant differences observed in the X-ray parameters and each domain of SRS-22 at one year postoperatively. This suggests that, to improve patient quality of life (QOL), it is essential for robotic-assisted spine surgery to focus not only on screw accuracy but also on the development of novel robotic-assisted techniques.
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STUDY DESIGN: Retrospective study. OBJECTIVE: The aim was to clarify the health-related quality of life (QOL) of patients who had adolescent idiopathic scoliosis (AIS) at a minimum of 40 years after surgery. SUMMARY OF BACKGROUND DATA: The postoperative health-related QOL of middle-aged patients with AIS has been reported to be good, but that of middle-aged and older patients with AIS has yet to be completely explored. MATERIALS AND METHODS: We included 179 patients with AIS who underwent spinal fusion(s) between 1968 and 1982. We conducted three surveys in 2009, 2014, and 2022. Patients self-administered both the Scoliosis Research Society-22 and the Roland-Morris Disability questionnaires three times (in 2009, 2014, and 2022) and the Oswestry Disability Index (ODI) questionnaire was self-administered in 2014 and 2022. We considered patients who responded to all three surveys in 2009, 2014, and 2022. RESULTS: For the Scoliosis Research Society-22 questionnaires, no significant differences were detected among the three time points (2009, 2014, and 2022) for total scores, function domain, pain domain, self-image domain, mental domain, or satisfaction domain. The results of the Roland-Morris Disability Questionnaire were also not significantly different among the surveys over time. The ODI questionnaires revealed a significant worsening of the 2022 results compared with the 2014 results. Eight patients (29.6%) who had an ODI deterioration of 10% or more had numerically fewer mobile lumbar disks than those with <10% deterioration of the ODI, although the difference did not reach statistical significance. CONCLUSION: Among patients with AIS who underwent spinal fusion(s) between 1968 and 1982, we found health-related QOL to be maintained over the last 13 years. Relatively good QOL was appreciated in this population of patients who are now middle-aged and older.
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Cifose , Escoliose , Fusão Vertebral , Pessoa de Meia-Idade , Humanos , Adolescente , Idoso , Escoliose/epidemiologia , Estudos Retrospectivos , Qualidade de Vida , Cifose/cirurgia , Dor , Inquéritos e Questionários , Resultado do Tratamento , Fusão Vertebral/métodosRESUMO
Introduction The purpose of this study was to evaluate robotic-assisted cortical bone trajectory (CBT) screw placement. Early, middle, and late phases of robotic-assisted CBT screw placement were compared for accuracy and screw insertion time by comparing time and accuracy in every phase. Methods A retrospective review was conducted on the initial 40 patients who underwent spinal fusion using CBT screws in one institution from September 2021 to September 2022 utilizing a spine surgery robot system (Mazor X Stealth Edition, Medtronic Inc., Dublin, Ireland). The inclusion criterion was one- or two-level posterior lumbar interbody fusion (PLIF). Exclusion criteria were 1) patients who underwent posterior-lateral fusion in other segments, 2) patients who underwent additional decompression in other segments, 3) patients who underwent reoperation, and 4) patients with spondylolysis. The deviation of the CBT screw was evaluated on computed tomography (CT) one week after surgery using the Gertzbein-Robbins grade system. The rate of Grade A was considered the perfect accuracy rate, and the rate of penetration of 2 mm or more (Grades C, D, and E) was calculated as the deviation rate. To assess the learning curve, patients were divided into three groups. The first 10 cases were in the early phase group, the subsequent 10 cases were in the middle phase group, and the last 10 cases were in the late phase group. We compared the perfect accuracy rate, deviation rate, operative time, operative time per segment, intraoperative blood loss, registration time, and screw insertion time among the three groups. Results Thirty patients met the criteria. Overall, the perfect accuracy (Grade A) rate of the screw was 95.3% and the deviation rate was 1.4%. The perfect accuracy rate was 90.4% in the early phase, 95.5% in the middle phase, and 100% in the late phase. The deviation rate was 3.8% in the early phase, 0% in the middle phase, and 0% in the late phase, and there was no statistically significant difference between the three groups. Among the three groups, the operative time, the operative time per segment, the intraoperative blood loss, and the registration time were not significantly different. There was no significant difference in the screw insertion time among the three groups, but it decreased with experience (early phase: 156.9 ± 54.7 sec, middle phase: 139.9 ± 41.6 sec, and late phase: 106.4 ± 39.9 sec, p=0.060). The screw insertion time of the late phase tended to be shorter than that of the early phase (p=0.052). Conclusions The deviation rate of robotic-assisted CBT screw placement with one- or two-level PLIF was 1.4%, which was highly accurate. The deviation rate was 3.8% in the early phase, 0% in the middle phase, and 0% in the late phase. Although the deviation rate was low even in the early period, the screw insertion time in the early 10 cases tended to be longer than that in the late 10 cases. After passing the experience of 10 cases, this study concluded that robotic-assisted CBT screw placement was proficient.
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Introduction: The purpose of this study was to clarify how many cases surgeons need to experience to pass the learning phase of robotic-assisted spine surgery using the cumulative sum (CUSUM) analysis. Methods: A retrospective review was conducted on the initial 50 consecutive patients who underwent robotic-assisted pedicle screw placements with open procedures using a spine robotic system (Mazor X Stealth Edition) at a single center from April 2021 to January 2022. There were 19 male and 31 female patients with a mean age of 58.7 (range, 13-86) years. To split the surgeries into the early and late phases using the CUSUM analysis of screw insertion time, we compared the screw insertion time, the robot setting time, the registration time, and the operation time in the early and late phases. Results: The screw insertion time, the robot setting time, and the registration time declined as the number of surgical cases increased. The operation time did not decline as the number of surgical cases increased. The learning curve for screw insertion time can be separated into two stages based on the CUSUM analysis. The first 23 cases were in the early phase, and the later 27 cases were in the late phase. The mean screw insertion time was reduced from 3.2 min in the first 23 cases to 2.7 min in the subsequent 27 cases. The robot setting time and registration time in the late phase were also significantly shorter than those in the early phase. Conclusions: The screw insertion time, robot setting time, and registration time decreased with experience. After 23 cases, surgeons passed the learning phase of robotic-assisted spine surgery and became more proficient.
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Introduction: The alpha-defensin lateral flow test has been used in periprosthetic joint infection as a diagnostic support tool because of its simplicity and speed. However, the test has not been used to diagnose spinal infections. The purpose of this study was to investigate the efficacy of the alpha-defensin lateral flow test for diagnosing spinal infections. Methods: The subjects were 11 patients who were suspected of having spinal infections from October 2019 to August 2021 and underwent biopsies at a single institution. There were nine male and two female patients, with an average age of 60.7 (14-87) years. For diagnosing infection, the patient's consent for biopsy was obtained, and the sample was collected by computed tomography-guided aspiration biopsy or open biopsy at the site considered to be a possible abscess. The samples were subjected to a bacterial culture test, an acid-fast bacillus culture test, and an alpha-defensin lateral flow test (Synovasureâ lateral flow test; Zimmer Biomet, IN, USA). Results: Of the 11 suspected spinal infections, the alpha-defensin lateral flow test was positive in 8 cases, negative in 2 cases, and undeterminable in 1 case. Of the 10 cases excluding the undeterminable case, the definitive diagnosis was 9 cases of spinal infection (spondylitis: 6 cases, spinal implant infection: 3 cases) and 1 case of vertebral body fracture. The alpha-defensin lateral flow test demonstrated a sensitivity of 88.9%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 50%. The biopsy sample culture test demonstrated a sensitivity of 77.8%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 33.3%. Conclusions: We suggested that the alpha-defensin lateral flow test might be useful as a diagnostic support tool for spinal infections.
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Introduction The purpose of this study was to clarify the superiority of robotic-assisted lumbar pedicle screw placement in terms of screw insertion time, fluoroscopy time, and operation time. Methods The subjects were 46 patients who underwent a posterior lumbar interbody fusion with an open procedure for lumbar degenerative disease from April 2021 to February 2022. The robot group contained 29 cases of screw insertion using a spine robotic system (Mazor X Stealth Edition, Medtronic Inc., Dublin, Ireland). The freehand group contained 17 cases of screw insertion with the freehand technique utilizing the conventional C-arm image guidance. The screw insertion time, fluoroscopy time, and operation time were compared between the robot and the freehand group. Results The screw insertion time did not differ significantly between the two groups (robot group: 179.0 ± 65.2 sec; freehand group: 164.2 ± 83.4 sec; p = 0.507). The fluoroscopy time was significantly shorter in the robot group (robot group: 28.3 ± 25.8 sec; freehand group: 67.5 ± 72.8 sec; p = 0.011). The fluoroscopy time per segment was also significantly shorter in the robot group (robot group: 17.8 ± 23.0 sec; freehand group: 60.2 ± 74.8 sec; p = 0.007). The operation time was significantly longer in the robot group (robot group: 249.6 ± 72.5 min; freehand group: 195.8 ± 60.1 sec; p = 0.013), but the operation time per segment did not differ significantly between the two groups (robot group: 144.1 ± 39.0 min; freehand group: 159.7 ± 34.4 min; p = 0.477). Conclusions The screw insertion time and operation time per segment were similar when employing the spine robotic system compared to the freehand technique; however, the fluoroscopy time was shorter. The fluoroscopy time per segment in the robot group was 29.6% of the time of the freehand group using the C-arm. The surgeon's radiation exposure is thought to be decreased since the spine robotic system shortens the fluoroscopy time.