Comparison of the short-term efficacies between robot-assisted cortical bone screw and pedicle screw fixations in posterior lumbar interbody fusion for patients with osteoporotic lumbar spinal stenosis

English Keywords:Lumbar Spinal Stenosis  TiRobot system  Cortical bone trajectory screws  Pedicle screws  Posterior lumbar interbody fusion  Osteoporosis

English Abstract:

  【Abstract】 Objectives: To compare the short-term effectiveness and safety between robot-assisted cortical bone trajectory screw(CBTS) and traditional pedicle screw(TPS) fixations in posterior lumbar interbody fusion(PLIF) for lumbar spinal stenosis with osteoporosis. Methods: We retrospectively analyzed the clinical data of 113 patients who underwent robot-assisted PLIF and internal fixation in our hospital between September, 2018 and June, 2021. The patients were divided into two groups according to the internal fixation method. 55 patients fixed with CBTS were included in the CBTS group, and 58 patients fixed with TPS were included in the TPS group. The general data[age, sex ratio, height, weight, body mass index(BMI), hip bone mineral density(BMD)], surgical related data(operative time, incision length, intraoperative blood loss), perioperative indicators(postoperative length of hospital stay, surgical complications, screw loosening rate, adjacent facet joint violation rate, preoperative and postoperative blood glucose), and visual analogue scale(VAS) score of pain and Oswestry disability index(ODI) before and after surgery were recorded and compared. Results: There was no significant difference in age, sex ratio, height, weight, BMI and hip BMD between the two groups(P>0.05). There was no significant difference in operative time, postoperative length of hospital stay, surgical complications, preoperative VAS score and ODI, and ODI at 1 month and 6 months after operation between the two groups(P>0.05). The intraoperative blood loss, length of incision and VAS score at 6 months after operation in the CBTS group were significantly lower than those in the TPS group(500mL vs 600mL, P=0.007; 8cm vs 10cm, P=0.006; 2 vs 3, P<0.001). There was no significant difference in blood glucose before operation and 1 day after operation between the two groups(P>0.05), while at 1 week after operation, the CBTS group was significantly lower than the TPS group(4.75mmol/L vs 5.57mmol/L, P=0.041). At the final follow-up, the rates of screw loosening and adjacent facet joint violation in CBTS group were significantly lower than those in TPS group(1.68% vs 4.52%, P=0.044 and 13.83% vs 26.53%, P=0.029). Conclusions: For patients with lumbar spinal stenosis combined with osteoporosis, PLIF with robot-assisted CBTS fixation is less in surgical trauma, faster in early postoperative recovery, and fewer in screw-related complications than with TPS fixation.