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Learning curve of junior surgeons in robot-assisted pedicle screw placement: a comparative cohort study

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Abstract

Objective

Robot-assisted technology has been gradually applied to pedicle screw placement in spinal surgery. This study was designed to detailedly evaluate the learning curve of junior surgeons in robot-assisted spine surgery.

Methods

From December 2020 to February 2022, 199 patients requiring surgical treatment with posterior pedicle screw fixation were prospectively recruited into the study. The patients were randomized to the robot-assisted group (the RA group) or the conventional freehand group (the CF group). Under the senior specialist’s supervision, pedicle screws were placed by two junior fellows without prior experience. Cumulative summation (CUSUM) analysis was performed on the learning curve of pedicle screw placement for performing quantitative assessment based on the time of screw insertion.

Results

In total, 769 and 788 pedicle screws were placed in the RA and CF groups. Compared with the CF group, the learning duration in the RA group was shorter in the upper thoracic region (57 vs. 70 screws), but longer in the lower thoracic (62 vs. 58 screws) and the lumbosacral region (56 vs. 48 screws). The slope of learning curve was lower in the RA group than in the CF group. The screw accuracy in the RA group was superior to that in the CF group, especially in upper thoracic region (89.4% vs. 76.7%, P < 0.001). This disparity of accuracy became wider in deformity cases. In the upper thoracic region, the mean placement time was 5.34 ± 1.96 min in the RA group and 5.52 ± 2.43 min in the CF groups, while in the lower thoracic and lumbosacral regions, the CF group's mean placement times were statistically shorter. Three screw-related neural complications occurred in the CF group.

Conclusion

Robot-assisted technique has its advantages in the upper thoracic region and deformity cases, which is easier and safer to insert pedicle screws. The robot-assisted technique allowed a short learning curve for junior surgeons and exhibited consistently excellent results even in the early application period.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the grants from National Natural Science Foundation (81802216, 82072418) and Shanghai Science and Technology Fund (20DZ2201300).

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Authors and Affiliations

  1. Department of Spine Surgery, Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200120, China

    Fan Feng, Xiuyuan Chen, Zude Liu, Yingchao Han, Hao Chen, Quan Li, Lifeng Lao & Hongxing Shen

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  1. Fan Feng
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  2. Xiuyuan Chen
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  3. Zude Liu
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  4. Yingchao Han
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  5. Hao Chen
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  6. Quan Li
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  7. Lifeng Lao
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  8. Hongxing Shen
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Correspondence to Lifeng Lao or Hongxing Shen.

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The authors declare that they have no conflict of interest.

Ethical approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki and STROCSS 2019 Guideline. Ethics approval was obtained from the Institutional Review Board of Renji Hospital, School of Medicine, Shanghai Jiao Tong University. Informed consent was obtained from all individual participants included in the study. This study was relevant to the study registered at chictr.org.cn (Number: ChiCTR2000040555).

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Fan Feng and Xiuyuan Chen are contributed equally to this work.

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Feng, F., Chen, X., Liu, Z. et al. Learning curve of junior surgeons in robot-assisted pedicle screw placement: a comparative cohort study. Eur Spine J 33, 314–323 (2024). https://doi.org/10.1007/s00586-023-08019-2

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  • DOI: https://doi.org/10.1007/s00586-023-08019-2

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