gms | German Medical Science

Objective: Robot-guided percutaneous insertion of pedicle screws for spinal instrumentation provides a minimally invasive surgical treatment for spondylodiscitis in which some of the patients present in critical condition with high perioperative risk. We performed a prospective case collection study of minimally invasive percutaneous robotic-guided instrumentation in spondylodiscitis patients. This cohort was compared to a historic spondylodiscitis cohort treated with conventional spinal instrumentation.

Method: 65 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected levels including decompression and antibiotic therapy according to microbiological germ results were analysed for clinical and radiological parameters. Accuracy of screw positioning according to Wiesner et al., X-ray exposure, intra- and postoperative course data were analyzed.

Results: 24 patients were treated by free-hand fluoroscopy guided surgery (122 screws) and 41 patients were treated by percutaneous robotic-guided spinal instrumentation (212 screws). 85.8% of robotic-guided screws in percutaneous and 67.2% of free-hand pedicle screw placement were found to be accurate (Grade 0 and 1). The average intra-operative X-Ray exposure per screw was 0.96±0.84 min in the free-hand compared to 0.38± 0.17 min in the percutaneous group (p=0.002). Intraoperative adverse events (haemorrhage, dural tears) were observed in 20.8% (5) of free-hand group and 7.5% (3) of percutaneous group. 37.5% (6) of the free-hand group and 5% (2) of the percutaneous group had wound revision surgery. Implant revision due to misplacement occurred in (6 screws) 4.9% in the freehand and (1 screw) 0.47% in the percutaneous group; in the further course due to loosening in 2 patients (8.3%) of the free-hand and 3 patients (7.1%) of the percutaneous group. Mean follow-up of the percutaneous group was 132 d (range 7-588). Except 1 patient who had a ventral instrumentation in another institution, no patient necessitated further surgical treatment in the follow-up time period.

Conclusions: This study demonstrates that percutaneous robotic-guided spinal instrumentation is a safe procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, decreased complication rates, less complicated perioperative course and lower radiation exposure. The combination of antibiotics and percutaneous transpedicular instrumentation is an effective treatment of spondylodiscitis.