A prospective, randomized, controlled trial of robot-assisted vs freehand pedicle screw fixation in spine surgery.
BACKGROUND
The purpose of this study was to compare the accuracy and safety of an instrumented posterior lumbar interbody fusion (PLIF) using a robot-assisted minimally invasive (Robot-PLIF) or a conventional open approach (Freehand-PLIF).


METHODS
Patients undergoing an instrumented PLIF were randomly assigned to be treated using a Robot-PLIF (37 patients) and a Freehand-PLIF (41 patients).


RESULTS
For intrapedicular accuracy, there was no significant difference between the groups (P = 0.534). For proximal facet joint accuracy, none of the 74 screws in the Robot-PLIF group violated the proximal facet joint, while 13 of 82 in the Freehand-PLIF group violated the proximal facet joint (P < 0.001). The average distance of the screws from the facets was 5.2 ± 2.1 mm and 2.7 ± 1.6 mm in the Robot-PLIF and Freehand-PLIF groups, respectively (P < 0.001).


CONCLUSIONS
Robotic-assisted pedicle screw placement was associated with fewer proximal facet joint violations and better convergence orientations.
Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Republic of Korea.
Ho-Joong
HJ
Kim
Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Republic of Korea.
Whan-Ik
WI
Jung
Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea.
Bong-Soon
BS
Chang
Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea.
Choon-Ki
CK
Lee
Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea.
Kyoung-Tak
KT
Kang
Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Republic of Korea.
Jin S
JS
Yeom
D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D065289:Pedicle Screws; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D014057:Tomography, X-Ray Computed
free-hand technique; posterior lumbar interbody fusion; proximal facet joint violation; randomized controlled trial; robot-assisted pedicle screw fixation