1. 2024;27;E953-E963Comparison of Robot-Assisted and Fluoroscopy-Assisted Percutaneous Kyphoplasty for Bone Cement Distribution and Clinical Efficacy
   Observational Study
   Hui Tao, PhD, Zhiwei Huang, MD, Shanzhong Shao, MD, Ruoyu Yang, MD, Kun Yang, PhD, Yinshun Zhang, PhD, Wei Li, PhD, Fulong Dong, PhD, Jun Qian, PhD, and Cailiang Shen, PhD.

BACKGROUND: The distribution of bone cement after percutaneous kyphoplasty (PKP) affects its clinical efficacy in patients with osteoporosis. Robotic and traditional treatment of osteoporotic vertebral compression fractures (OVCFs) have both been established as effective, but no studies have compared these 2 modalities in terms of bone cement distribution and clinical outcomes.

OBJECTIVE: To compare the bone cement distribution and clinical efficacy of robot-assisted percutaneous kyphoplasty to those of fluoroscopy-assisted percutaneous kyphoplasty for the treatment of OVCFs.

SETTING: Department of Orthopedics and Spine Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China.

STUDY DESIGN: A single-center, retrospective observational study.

METHODS: Data from 151 patients with OVCFs who underwent PKP between January 2020 and July 2022 were analyzed retrospectively. The patients were divided into 3 groups: robot-assisted unipedicular percutaneous kyphoplasty (RAUPK), fluoroscopy-assisted unipedicular percutaneous kyphoplasty (FAUPK), and fluoroscopy-assisted bipedicular percutaneous kyphoplasty (FABPK). The operation time, intraoperative blood loss, bone cement injection volume, bone cement distribution, and complications (vascular and nerve injury, bone cement leakage, and re-fracture) of each procedure were recorded. The visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, Cobb angle, and anterior height of the injured vertebrae were compared among the 3 groups preoperatively, one day postoperatively, and at the final follow-up.

RESULTS: No puncture failures occurred in any of the 3 groups. The mean follow-up period was 20.0 ± 5.2 months. The postoperative VAS scores, ODI, anterior vertebral heights, and Cobb angles of all patients were significantly improved compared to the preoperative values (P < 0.05). There were no significant differences in the VAS score, ODI score, Cobb angle, anterior vertebral height ratio preoperatively or one day postoperatively among the 3 groups (P > 0.05). The groups’ comparative rates of intraoperative blood loss and complications also showed no significant differences (P > 0.05). At the last follow-up, the VAS and ODI scores of the RAUPK group were lower than those of the FAUPK group (P < 0.05), as were the anterior height of the injured vertebra and Cobb angle of the RAUPK group (P < 0.05). The operation time, bone cement injection volume, and bone cement distribution in the RAUPK group were superior to those in the FAUPK group (P < 0.05). Nevertheless, there were no significant differences in the VAS, ODI, Cobb angle, or anterior vertebral height at the last follow-up between the FABPK group and the RAUPK group (P > 0.05). Those 2 groups also showed no significant difference in operation time, intraoperative blood loss, bone cement distribution, or complication rate (P > 0.05). However, the patients in the RAUPK group were injected with a greater volume of bone cement than were those in the FABPK group (P < 0.05).

LIMITATIONS: This was a single-center, retrospective, nonrandomized study, which is a major limitation.

CONCLUSION: Robot-assisted percutaneous kyphoplasty can establish an optimal path via the unipedicular approach, thereby effectively mitigating the potential risks associated with vascular nerve and cortical bone injuries. Additionally, RAUPK ensures a more favorable distribution of bone cement and provides superior pain relief for patients. Furthermore, RAUPK has greater long-term efficacy than does FAUPK.

KEY WORDS: Percutaneous kyphoplasty, TiRobot, unilateral pedicle approach, osteoporotic vertebral compression fractures, optimal path, bone cement distribution