A study published in the International Spine Journal indicates that robotic assistance increases the accuracy and reduces complications associated with spinal tumour surgery.
Xiaobang Hu, Texas Back Institute, Plano, USA, led the study, the purpose of which was to evaluate early experience using robotic guidance in the treatment of spinal tumours. Hu and colleagues write that robotic surgery is one of a variety of new techniques that have “shown some promising results by improving the accuracy of spinal instrumentation and reducing potential complications.” This study used Mazor Robotics’ Renaissance device, which guides the surgeon in the placement of spinal instrumentation according to a preoperatively-planned trajectory.
The authors collected data from medical records for each surgery in which the robotic system was used to assist with biopsy, pedicle screw placement and/or vertebral augmentation in the treatment of spinal tumours. Each patient’s age (mean age of the patients was 60 years, range 47–69), gender, diagnosis and surgical procedure were documented and the surgical time, estimated blood loss, perioperative and post-operative complications were obtained. The visual analogue scale (VAS) for back pain and leg pain were also recorded as outcome measures. A total of nine consecutive patients (seven female and two male) were included in this study, beginning with the first case experience. All patients presented with thoracic or lumbar vertebral collapse and/or myelopathy and all cases were performed by the same surgeon to ensure consistent results.
Hu et al report, “Robotic assisted posterior instrumentation was successfully performed in all patients”. Robotic assisted vertebral augmentation was performed in four of the patients, with an average number of levels instrumented of five. The average surgery time was four hours and 24 minutes and the mean blood loss was 319ml. There were no complications perioperatively or through the latest follow-up. Seven of the nine patients reported improved back pain (postoperative scores ranged from 0 to 5) and/or leg pain (postoperative pain ranged from 0 to 4.6) at the latest follow-up. Data were not available in two patients.
Hu and colleagues write, “The published complication rates of spinal tumour surgeries range between 5.3% and 19%. With robotic assistance, the surgical complication rate appears improved over the historical figures. Our study shows that the robotic system was safe and performed as desired in the treatment of metastatic and primary spine tumours. These results support that further evaluation in a larger series of patients.”
Hu et al continue, “robotic navigation offers the potential benefits of precise pre-operative planning for the more suitable entry points and more appropriate trajectories, via a strategic less invasive exposure, and intraoperative execution of the surgical plan.”