Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 24;22(1):284.
doi: 10.1186/s12893-022-01733-6.

Predictors of accurate intrapedicular screw placement in single-level lumbar (L4-5) fusion: robot-assisted pedicle screw, traditional pedicle screw, and cortical bone trajectory screw insertion

Hua-Qing Zhang #  1 , Can-Can Wang #  1 , Ren-Jie Zhang #  1 , Lu-Ping Zhou  1 , Chong-Yu Jia  1 , Peng Ge  1 , Cai-Liang Shen  2
Affiliations

Predictors of accurate intrapedicular screw placement in single-level lumbar (L4-5) fusion: robot-assisted pedicle screw, traditional pedicle screw, and cortical bone trajectory screw insertion

Hua-Qing Zhang et al. BMC Surg. .

Abstract

Background: The superiorities in proximal facet joint protection of robot-assisted (RA) pedicle screw placement and screw implantation via the cortical bone trajectory (CBT) have rarely been compared. Moreover, findings on the screw accuracy of both techniques are inconsistent. Therefore, we analyzed the screw accuracy and incidence of facet joint violation (FJV) of RA and CBT screw insertion in the same study and compared them with those of conventional pedicle screw (PS) insertion. The possible factors affecting screw accuracy and FJV were also analyzed.

Methods: A total of 166 patients with lumbar degenerative diseases requiring posterior L4-5 fusion were retrospectively included and divided into the RA, PS, and CBT groups from March 2019 to December 2021. The grades of intrapedicular accuracy and superior FJV were evaluated according to the Gertzbin-Robbins scale and the Babu scale based on postoperative CT. Univariable and multivariable analyses were conducted to assess the possible risk factors associated with intrapedicular accuracy and superior FJV.

Results: The rates of optimal screw insertion in the RA, PS, and CBT groups were 87.3%, 81.3%, and 76.5%, respectively. The difference between the RA and CBT groups was statistically significant (P = 0.004). Superior FJVs occurred in 28.2% of screws in RA, 45.0% in PS, and 21.6% in CBT. The RA and CBT groups had fewer superior FJVs than the PS group (P = 0.008 and P < 0.001, respectively), and no significant difference was observed between the RA and CBT groups (P = 0.267). Multivariable analysis revealed that the CBT technique was an independent risk factor for intrapedicular accuracy. Furthermore, older age, the conventional PS technique and a smaller facet angle were independently associated with the incidence of superior FJVs.

Conclusions: The RA and CBT techniques were associated with fewer proximal FJVs than the PS technique. The RA technique showed a higher rate of intrapedicular accuracy than the CBT technique. The CBT technique was independently associated with screw inaccuracy. Older age, conventional PS technique and coronal orientation of the facet join were independent risk factors for superior FJV.

Keywords: Cortical bone trajectory; Minimally invasive surgery; Proximal facet joint violation; Robotic‐assisted pedicle screw; Screw accuracy; Traditional pedicle screw.

PubMed Disclaimer

Conflict of interest statement

The authors confirm that they have no competing interests.

Figures

Fig. 1
Fig. 1
Grades of intrapedicular accuracy and facet joint violation: A grade A, B grade B, C grade C, D grade D, and E grade E; F Grade 0, G Grade 1, H Grade 2, and I Grade 3
Fig. 2
Fig. 2
Measurement of superior facet angle (A) and incision depth (B)
See this image and copyright information in PMC

References

    1. Vaccaro AR, Garfin SR. Pedicle-screw fixation in the lumbar spine. J Am Acad Orthop Surg. 1995;3(5):263–274. doi: 10.5435/00124635-199509000-00002. - DOI - PubMed
    1. Boden SD. Overview of the biology of lumbar spine fusion and principles for selecting a bone graft substitute. Spine (Phila Pa 1976) 2002;27(16 Suppl 1):S26–S31. doi: 10.1097/00007632-200208151-00007. - DOI - PubMed
    1. Irmola TM, Häkkinen A, Järvenpää S, Marttinen I, Vihtonen K, Neva M. Reoperation rates following instrumented lumbar spine fusion. Spine. 2018;43(4):295–301. doi: 10.1097/BRS.0000000000002291. - DOI - PubMed
    1. Yang JY, Lee J, Song H. The impact of adjacent segment degeneration on the clinical outcome after lumbar spinal fusion. Spine (Philadelphia, Pa. 1976) 2008;33(5):503–507. doi: 10.1097/BRS.0b013e3181657dc3. - DOI - PubMed
    1. Yugué I, Okada S, Masuda M, Ueta T, Maeda T, Shiba K. Risk factors for adjacent segment pathology requiring additional surgery after single-level spinal fusion: impact of pre-existing spinal stenosis demonstrated by preoperative myelography. Eur Spine J. 2016;25(5):1542–1549. doi: 10.1007/s00586-015-4185-6. - DOI - PubMed

LinkOut - more resources