Comparison of clinical outcomes of corrective surgery for adolescent idiopathic scoliosis-robot-assisted technique vs. freehand technique

10.6492/FJMD.202208_13(3).0001

Yuan-Shao Chen；Yu-Hsien Lin；Yun-Che Wu；Cheng-Min Shih；Kun-Huei Chen；Cheng-Hung Lee；Wen-Hsien Lu；Chien-Chou Pan

adolescent idiopathic scoliosis ； complication rates ； freehand ； robot-assisted

Formosan Journal of Musculoskeletal Disorders

13卷3期（2022 / 08 / 01）

107 - 115

英文

Introduction: Corrective surgery with posterior instrumentation using pedicle screws is the gold standard surgical procedure for adolescent idiopathic scoliosis (AIS). Its accuracy has been greatly improved since the emergence of robot technology which had been well-validated in published literature. However, researches concerning complications were still rare. The present study aims to examine the complication rates of robot-assisted technique compared with freehand method. Purposes: The authors compared the clinical and implant-related complication rates of AIS patients treated surgically with all pedicle screws instrumentation between the robot-assisted (RO) and the freehand (FH) groups. Methods: The medical records of AIS patients receiving posterior instrumentation between April 2013 and December 2020 were retrospectively reviewed. Forty patients (21 in the RO group, 19 in the FH group) were eligible with minimum follow-up period of 1 year. Mann-Whitney U test was performed to assess differences of continuous variables between the two groups; while for categorical variables, Chi-squared test was employed. Clinical complication events included neurological deficit, vascular injury, hemopneumothorax, urinary tract infection, deep surgical site infection, superficial wound infection and postoperative chronic pain and numbness, etc. Implant-related complications comprised screw loosening, pullout, breakage, rod dislodge or failure. Results: Pedicle screw density was significantly higher in the RO group (2.0, 1.8-2.0) (median, interquartile range) compared to the FH group (1.1, 0.8-1.8). The operation time per screw, total blood loss, and blood loss per screw were all similar between the two cohorts. Clinical complication rate was significantly lower in the RO group as compared to the FH group (4.8% and 31.6%, respectively). Implant-related complication was not different. As for overall complication rates, robot-assisted technique yielded a significant reduction (9.5% vs. 52.6%, p = 0.009). Conclusion: Robot-assisted pedicle screw placement can achieve lower complication rates as compared to freehand fashion in corrective surgery for AIS patients.