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<p>The purpose of the current study was to evaluate the anatomical feasibility and the clinical efficacy of robot-assisted unilateral percutaneous kyphoplasty (PKP) via the extreme lateral transverse process-pedicle approach (ETPA) in treating osteoporotic vertebral compression fractures (OVCF). Researchers analyzed 1000 lumbar vertebrae (L1–L5) from 200 patients and simulated PKP via the ETPA using 3D-CT imaging. The distance between the entry point and the midline of the vertebral body (DEM), the puncture inclination angle (PIA), the safe range of the puncture inclination angles (SRP), the success rate (SR) of puncture, sagittal inclination angle (SIA), and the safe range of the sagittal inclination angle (SRS) were measured and compared. Additionally, we conducted a preliminary study of robot-guided unilateral PKP via ETPA in 20 patients with OVCF. The DEM in the ETPA group was larger than that in the conventional transpedicular approach (CTA) group. There were significant differences in the mean DEM between males and females. The ΔDEM increased significantly from 5.4 to 7.9 mm from L1 to L5. The PIA in the ETPA group was significantly greater than that in the CTA group. In both groups, the PIA in males was higher than that in females. The SR from L1 to L5 was 94.5% to 100% in the ETPA group and 37.25% to 99.75% in the CTA group. The SIA in males was significantly larger than that in females for L1 to L4. Guided by the surgical robot, an extreme lateral working channel was established via a unilateral pedicle approach. The total operative duration averaged 40.9 ± 4.9 min, with intraoperative blood loss of 6.3 ± 2.1 mL. The VAS score was 7.1 ± 1.1 before surgery and 2.7 ± 0.9 post-surgery (<i>p</i> &lt; 0.05), and the injected bone cement volume was 4.3 ± 1.0 mL. The learning curve is short, and the operative time tends to stabilize after the fourth surgery. The ETPA group exhibited larger DEM, greater PIA, and higher SR compared to the CTA group. Robot-assisted PKP performed via ETPA may achieve better distribution of bone cement.</p>

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Surgical robot-guided unilateral percutaneous kyphoplasty: anatomical features and clinical efficacy of a modified transverse process-pedicle approach

  • 期刊论文

  • 发表日期：

    2025年8月31日

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  • Zhuanghui Wang,
  • Yuanfeng Wang,
  • Hao Chen,
  • Run Zhang,
  • Jue Zhang,
  • Qinghong Ma,
  • Chao Sun

摘要

The purpose of the current study was to evaluate the anatomical feasibility and the clinical efficacy of robot-assisted unilateral percutaneous kyphoplasty (PKP) via the extreme lateral transverse process-pedicle approach (ETPA) in treating osteoporotic vertebral compression fractures (OVCF). Researchers analyzed 1000 lumbar vertebrae (L1–L5) from 200 patients and simulated PKP via the ETPA using 3D-CT imaging. The distance between the entry point and the midline of the vertebral body (DEM), the puncture inclination angle (PIA), the safe range of the puncture inclination angles (SRP), the success rate (SR) of puncture, sagittal inclination angle (SIA), and the safe range of the sagittal inclination angle (SRS) were measured and compared. Additionally, we conducted a preliminary study of robot-guided unilateral PKP via ETPA in 20 patients with OVCF. The DEM in the ETPA group was larger than that in the conventional transpedicular approach (CTA) group. There were significant differences in the mean DEM between males and females. The ΔDEM increased significantly from 5.4 to 7.9 mm from L1 to L5. The PIA in the ETPA group was significantly greater than that in the CTA group. In both groups, the PIA in males was higher than that in females. The SR from L1 to L5 was 94.5% to 100% in the ETPA group and 37.25% to 99.75% in the CTA group. The SIA in males was significantly larger than that in females for L1 to L4. Guided by the surgical robot, an extreme lateral working channel was established via a unilateral pedicle approach. The total operative duration averaged 40.9 ± 4.9 min, with intraoperative blood loss of 6.3 ± 2.1 mL. The VAS score was 7.1 ± 1.1 before surgery and 2.7 ± 0.9 post-surgery (p < 0.05), and the injected bone cement volume was 4.3 ± 1.0 mL. The learning curve is short, and the operative time tends to stabilize after the fourth surgery. The ETPA group exhibited larger DEM, greater PIA, and higher SR compared to the CTA group. Robot-assisted PKP performed via ETPA may achieve better distribution of bone cement.