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Roboterassistierte Implantation von Pedikelschrauben

Robot-assisted pedicle screw placement

  • Operative Techniken
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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Dorsale Instrumentierung der Wirbelsäule mit Pedikelschrauben.

Indikationen

Instabilität der Wirbelsäule durch Trauma, Infektion, Degeneration oder Tumor.

Kontraindikationen

Keine.

Operationstechnik

Navigierte und roboterassistierte Schraubenimplantation ermöglicht eine optimale Platzierung von Pedikelschrauben.

Weiterbehandlung

Frühfunktionelle Mobilisation ab dem ersten postoperativen Tag.

Ergebnisse

Eine Studie von Lee et al. analysierte den Einsatz des Systems Mazor X Stealth Edition (Medtronic Navigation, Louisville, CO, USA; Medtronic Spine, Memphis, TN, USA) in 186 Fällen mit insgesamt 1445 Pedikelschrauben [1]. Eine bildgebend korrekte Schraubenlage zeigte sich in 1432 (99,1 %) der Pedikelschrauben, 6 Pedikelschrauben (0,4 %) wurden intraoperativ revidiert. Die mittlere Dauer der Schraubenanlage betrug 6,1 ± 2,3 min. Pojskić et al. publizierten eine Fallserie zum Einsatz des Systems Cirq (Brainlab, München, Deutschland) mit 13 Fällen und Implantation von insgesamt 70 Pedikelschrauben [2]. Intraoperative Bildgebung zeigte eine Schraubenlage gemäß Gertzbein-Robbins-Klassifikation (GR) Kategorie A in 65 Schrauben (92,9 %) und GR B in 1 Schraube (1,4 %). Eine Schraubenlage GR D mit intraoperativer Revision zeigte sich in 2 Fällen (2,9 %). Die mittlere Dauer der Schraubenanlage betrug 08:27 ± 06:54 min.

Abstract

Objective

Pedicle screw-based posterior instrumentation of the spine.

Indications

Instability of the spine due to trauma, infection, degenerative spinal disease or tumor.

Contraindications

None.

Surgical technique

Robot-assisted navigated pedicle screw placement.

Postoperative management

Early functional mobilization starting on the first postoperative day.

Results

A study by Lee et al. analyzed the clinical application of the system Mazor X Stealth Edition (Medtronic Navigation, Louisville, CO, USA; Medtronic Spine, Memphis, TN, USA) in 186 cases with a total of 1445 pedicle screws [1]. Correct screw positioning was achieved in 1432 pedicle screws (99.1%); six pedicle screws (0.4%) were revised intraoperatively. The mean duration of pedicle screw placement was 6.1 ± 2.3 min. Pojskić et al. published a case series regarding the application of the system Cirq (Brainlab, Munich, Germany) in 13 cases with a total number of 70 pedicle screws implanted [2]. Intraoperative imaging showed screw positioning according to the Gertzbein Robbins classification (GR) category A in 65 screws (92.9%) and GR B in one screw (1.4%). Screw positioning GR D with intraoperative revision was reported in two screws (2.9%). Mean duration of pedicle screw placement was 08:27 ± 06:54 min.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurochirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    Maximilian Schwendner,  Bernhard Meyer &  Sandro M. Krieg

Authors
  1. Maximilian Schwendner
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  2. Bernhard Meyer
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  3. Sandro M. Krieg
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Corresponding author

Correspondence to Sandro M. Krieg.

Ethics declarations

Interessenkonflikt

B. Meyer und S.M. Krieg sind Berater für die Brainlab AG. B. Meyer erhält Beraterentgelte und Lizenzgebühren von Medacta International SA; erhält Honorare, Beraterentgelte und Forschungsmittel von Medtronic GmbH, Icotec AG und Relievant Medsystems Inc.; erhält Honorare und Forschungsmittel von Ulrich Medical GmbH; erhält Honorare und Beratungsentgelte von Spineart Deutschland GmbH und DePuy Synthes (Johnson&Johnson Medical GmbH) und erhält Lizenzgebühren von Spineart Deutschland GmbH. S.M. Krieg ist Berater für Ulrich Medical GmbH und erhält Honorare von Nexstim Plc, Spineart Deutschland GmbH, Medtronic GmbH, Carl Zeiss Meditec AG und DePuy Synthes (Johnson&Johnson Medical GmbH). M. Schwendner gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Ralph Kothe, Hamburg

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Schwendner, M., Meyer, B. & Krieg, S.M. Roboterassistierte Implantation von Pedikelschrauben. Oper Orthop Traumatol 35, 37–42 (2023). https://doi.org/10.1007/s00064-022-00792-5

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