Shi Fangfu,He Xianbo,Li Guojun,et al.Precision of screw insertion in Lenke 1A adolescent idiopathic scoliosis using spinal robotics plus simplified intraoperative calibration[J].Journal of Clinical Pediatric Surgery,2026,(01):20-25.[doi:10.3760/cma.j.cn101785-202507046]
Precision of screw insertion in Lenke 1A adolescent idiopathic scoliosis using spinal robotics plus simplified intraoperative calibration
- Keywords:
- Scoliosis; Robotic Surgical Procedures; Vertebral Body; Bone Nails; Child
- Abstract:
- Objective To explore the accuracy of pedicle screw placement in adolescent idiopathic scoliosis (AIS) patients assisted by spinal robotics plus a simplified intraoperative calibration technique. Methods For this retrospective study,42 children with Lenke type 1A adolescent idiopathic scoliosis (AIS) underwent corrective surgery at First Affiliated Hospital of Hainan Medical University between March 2023 and March 2025.Based upon whether or not intraoperative robotic calibration technique was applied,they were assigned into two groups of robotic (n=22) and robotic calibration (n=20).Baseline demographic profiles,Risser grade,number of pedicle screws and perioperative Cobb angles were recorded for both groups.The accuracy of pedicle screw placement was evaluated according to the Rao classification scheme. Results A total of 866 pedicle screws were inserted in both groups,including 450 screws in robotic group and 416 screws in robotic calibration group.The excellent screw placement rate was 97.60% in robotic calibration group and 92.18% in robotic group (P<0.05).Moreover,concave-side excellent screw rate (96.10%) and the proportion of concave-side grade 1 screws (6.90%) in robotic calibration group were also significantly higher than those in robotic group (88.16% and 0.50%,respectively) (P<0.05).In addition,overall medial cortical breach rate (0.5%) and concave-side medial cortical breach rate (0.5%) in robotic calibration group were significantly lower than those in robotic group (4.4% and 5.9%,respectively),whereas lateral cortical breach rate (3.4%) was significantly higher than that in robotic group (2.2%) (P<0.05 for all).No severe spinal cord,nerve or vascular injuries occurred in neither groups. Conclusions Intraoperative spinal vibration and vertebral rotation may affect the accuracy of pedicle screw placement using spinal robotics.And using a simplified intraoperative calibration technique significantly improves the overall and concave-side pedicle screw placement accuracy in Lenke type 1A AIS children,lower medial cortical breach rate and thereby enhance surgical safety during AIS corrections.
References:
[1] 张百慧,叶文松,朱伟玮,等.青少年特发性脊柱侧凸矫形术后adding-on现象的研究进展[J].临床小儿外科杂志,2020,19(2):140-144.DOI:10.3969/j.issn.1671-6353.2020.02.010. Zhang BH,Ye WS,Zhu WW,et al.Research advances of adding-on phenomenon after operations for adolescent idiopathic scoliosis[J].DOI:10.3969/j.issn.1671-6353.2020.02.010.
[2] G?nder N,?ztürk C,Ta?demir R,et al.Morphological and morphometric assessment of adolescent idiopathic scoliosis according to pelvic axial rotation-a retrospective cohort study with 397 patients[J].Children (Basel),2025,12(8):991.DOI:10.3390/children12080991.
[3] Al-Naseem AO,Al-Muhannadi A,Ramadhan M,et al.Robot-assisted pedicle screw insertion versus navigation-based and freehand techniques for posterior spinal fusion in scoliosis:a systematic review and meta-analysis[J].Spine Deform,2024,12(5):1203-1215.DOI:10.1007/s43390-024-00879-y.
[4] Chen YS,Lin YH,Wu YC,et al.Radiographic and clinical outcomes of robot-assisted pedicle screw instrumentation for adolescent idiopathic scoliosis[J].Front Surg,2024,11:1344802.DOI:10.3389/fsurg.2024.1344802.
[5] 翟功伟,高延征,高坤,等.脊柱机器人辅助与传统后路椎弓根螺钉内固定矫形术治疗脊柱侧凸的效果比较[J].中华实用诊断与治疗杂志,2019,33(7):636-640.DOI:10.13507/j.issn.1674-3474.2019.07.003. Zhai GW,Gao YZ,Gao K,et al.Outcome comparison of robot-assisted versus traditional posterior pedicle screw internal fixation for scoliosis[J].J Chin Pract Diagn Ther,2019,33(7):636-640.DOI:10.13507/j.issn.1674-3474.2019.07.003.
[6] Li C,Li H,Su JX,et al.Comparison of the accuracy of pedicle screw placement using a fluoroscopy-assisted free-hand technique with robotic-assisted navigation using an O-arm or 3D C-arm in scoliosis surgery[J].Global Spine J,2024,14(4):1337-1346.DOI:10.1177/21925682221143076.
[7] 何贤波,陈焕雄,孟志斌,等.术中导航校准技术辅助下青少年特发性脊柱侧凸顶椎区置钉精确性研究[J].中国脊柱脊髓杂志,2022,32(9):795-804.DOI:10.3969/j.issn.1004-406X.2022.09.04. He XB,Chen HX,Meng ZB,et al.Accuracy of screw placement in apical region of adolescent idiopathic scoliosis assisted by intraoperative navigation and calibration[J].Chin J Spine Spinal Cord,2022,32(9):795-804.DOI:10.3969/j.issn.1004-406X.2022.09.04.
[8] Sarwahi V,Sugarman EP,Wollowick AL,et al.Prevalence,distribution,and surgical relevance of abnormal pedicles in spines with adolescent idiopathic scoliosis vs.no deformity:a CT-based study[J].J Bone Joint Surg Am,2014,96(11):e92.DOI:10.2106/JBJS.M.01058.
[9] Sakti YM,Lanodiyu ZA,Ichsantyaridha M,et al.Pedicle morphometry analysis of main thoracic apex adolescent idiopathic scoliosis[J].BMC Surg,2023,23(1):34.DOI:10.1186/s12893-022-01877-5.
[10] Jin MR,Liu Z,Qiu Y,et al.Incidence and risk factors for the misplacement of pedicle screws in scoliosis surgery assisted by O-arm navigation-analysis of a large series of one thousand,one hundred and forty five screws[J].Int Orthop,2017,41(4):773-780.DOI:10.1007/s00264-016-3353-6.
[11] Chang CN,Li CR,Liao SS,et al.Augmented reality in scoliosis correction surgery:efficiency and accuracy in pedicle screw instrumentation[J].Medicina (Kaunas),2025,61(4):576.DOI:10.3390/medicina61040576.
[12] Hou CL,Yang H,Chen Y,et al.Comparison of robot versus fluoroscopy-assisted pedicle screw instrumentation in adolescent idiopathic scoliosis surgery:a retrospective study[J].Front Surg,2023,9:1085580.DOI:10.3389/fsurg.2022.1085580.
[13] Li C,Wang Z,Li DL,et al.Safety and accuracy of cannulated pedicle screw placement in scoliosis surgery:a comparison of robotic-navigation,O-arm-based navigation,and freehand techniques[J].Eur Spine J,2023,32(9):3094-3104.DOI:10.1007/s00586-023-07710-8.
[14] Akazawa T,Torii Y,Ueno J,et al.Comparison of radiographic and patient-reported outcomes after surgery in adolescent idiopathic scoliosis between robotics and navigation:an analysis using propensity score matching[J].Cureus,2023,15(11):e49061.DOI:10.7759/cureus.49061.
Memo
收稿日期:2025-7-21。
基金项目:国家自然科学基金(82160435);2024年度海南省高等学校科学研究项目(Hnky24—28)
通讯作者:陈焕雄,Email:chenhuanxiong86@163.com