Efficacy analysis of direct linear transformation algorithm robot-assisted modified TESSYS surgery for lumbar disc herniation

English Keywords:Lumbar intervertebral disc herniation  DLT algorithm  Robot  Intervertebral foraminoscopy  Puncture  Articular process formation

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacy of direct linear transformation(DLT) algorithm robot-assisted modified transforaminal endoscopic spine system(TESSYS) with conventional modified TESSYS in the treatment of lumbar disc herniation, and to explore the application value of DLT algorithm robot-assisted modified TESSYS surgery. Methods: A retrospective analysis was conducted on the data of 43 patients with lumbar disc herniation who underwent modified TESSYS surgery assisted with robot and conventional techniques from June 2022 to June 2023 in the 8th Medical Center, PLA General Hospital. There were 24 males and 19 females, with an average age of 51.44±19.14(15-89)years. 15 cases were treated with DLT algorithm robot-assisted modified TESSYS surgery(robot group) and 28 cases underwent modified TESSYS surgery using conventional methods(conventional group). There were no significant differences in age, gender, body mass index(BMI), surgical segment, and type of protrusion between the two groups(P>0.05). The number of punctures, fluoroscopy times, time before articular process formation, formation time, operative time, and visual analogue scale(VAS) score and Oswestry disability index(ODI) before and after surgery and at the final follow-up between two groups of patients were compared. The efficacy was evaluated with the modified Macnab scores at the final follow-up. Results: All the patients completed the operations. In the conventional group, 1 case had intraoperative dural injury, no cerebrospinal fluid leakage after close suture, and no obvious postoperative symptoms, no hematoma, nerve injury, infection or other complications. In the robot group, no significant complications were observed, and postoperative decompression of nerve root was sufficient. The number of punctures was 1.67±0.82 times in the robot group and 7.89±1.91 times in the conventional group, with statistical difference(P<0.05). The number of fluoroscopy was 12.27±1.44 times in the robot group and 19.71±1.44 times in the conventional group, with statistical difference(P<0.05). The time before articular process formation of the robot group was significantly less than that of the conventional group(6.33±1.50min vs 16.21±4.61min, P<0.05). The formation time of articular process wasn′t significantly different between the robot group and conventional group(16.60±2.53min vs 20.11±7.21min, P>0.05). There was significant difference in operative time between the robot group and conventional group(71.27±11.33min vs 85.21±19.08min, P<0.05). The VAS scores were 6.33±1.05 points, 2.73±1.39 points and 1.27±0.46 points in the robot group and 6.21±0.96 points, 2.57±0.63 points and 1.43±0.57 points in the conventional group before surgery, on 1d after surgery and at the final follow-up, respectively. The VAS scores after operation improved significantly than before operation in both groups(P<0.05), and there were no significant differences between the two groups at the same time point(P>0.05). The ODI of the robot group before surgery, on 1d after surgery and at the final follow-up were (39.75±3.95)%, (16.92±5.04)% and (9.72±2.62)%, while those of the conventional group were (41.86±3.74)%, (16.84±2.76)% and (9.21±2.77)%, respectively. The postoperative ODI were statistically different from those before operation in both groups(P<0.05), but no statistical differences between the two groups was found at the same time point(P>0.05). There was no significant difference in the follow-up time between the two groups, and no significant difference was there in the excellent and good rate of modified Macnab classification at the final follow-up(93.3% in the robot group vs 92.9% in the conventional group, P<0.05). Conclusions: Compared with conventional modified TESSYS surgery, DLT algorithm robot-assisted modified TESSYS surgery under local anesthesia can reduce the number of puncture times, fluoroscopy times, operative time before articular process formation, and operative time in the treatment of lumbar disc herniation.