Osteoporotic vertebral compression fractures often occur during inadvertent daily activities, causing pain, hunchback, and height shortening, which seriously affect the quality of life of the elderly. Percutaneous vertebral balloon distension kyphoplasty (PKP) is now an internationally recognized treatment method. Director Wang Boyao and his team at the Second Affiliated Hospital of Southern Medical University successfully completed percutaneous balloon kyphoplasty (PKP) with the assistance of a minimally invasive spine surgery robot. The patient's lumbar spine compression fracture, with the help of 3D imaging + intelligent navigation full process solution with high precision, made the surgery more efficient and accurate.

Percutaneous vertebral body balloon dilatation kyphoplasty (PKP) is performed after intraoperative C-arm X-ray fluoroscopy to target the diseased vertebral body, make 1-2 incisions of about 5-6 mm in the patient's back, insert the vertebral body through skin puncture with a special puncture needle under 3D C-arm guidance, place the expandable balloon, expand to a satisfactory degree, and reset the compressed vertebral body. Bone cement is injected and the dilated area is filled and fixed.

Patient information

Case name: Percutaneous vertebral body balloon dilatation kyphoplasty (PKP)

Patient age: 60-year-old patient

Gender: male

Patient's condition: lumbar compression fracture (lumbar 4)

Preoperative examination

Clinical procedure.

A flat 3D C-arm is used to take a frontal and lateral view of the surgical site, determine the surgical site, install a patient tracer, acquire 3D images and send them to the minimally invasive spine surgery robot system. During the clinical procedure, the minimally invasive spine surgery robot system performs overall planning of the vertebral body to be operated on (point of entry, angle of entry, depth of entry), and after the planning is completed, the robot arm executes the planning instructions. The bone expander (balloon) is inserted. The balloon expands to restore the height of the vertebral body, creates a cavity in the vertebral body, determines the dose of bone cement to be injected, and simultaneously injects the bone cement to observe its diffusion. The minimally invasive spine surgery robot-assisted surgery greatly reduces the risk of surgery and shortens the operation time.

Intraoperative images

Minimally invasive spine surgery robot planning

Postoperative images

Difficult points of PKP surgery

The puncture path and the puncture process should be designed according to the fracture type and the degree of compression before surgery. If the puncture inversion angle is too large, there is an increased risk of the puncture needle entering the spinal canal and damaging the neurological spinal cord, while too small results in the balloon being too far to the side of the vertebral body and balloon expansion may result in a peri-vertebral wall fracture. The spinal minimally invasive surgery robot allows for accurate positioning and successful puncture in one pass, avoiding repeated fluoroscopy, which may require repeated adjustments of the puncture direction and angle for less experienced surgeons.

The advantages of using a minimally invasive spine surgery robot and a flat 3D C-arm are

1. Minimization of traditional surgery: less trauma and faster healing.

2. Standardization and intelligence of complex surgery: one-time path planning for difficult spine surgery, greatly reducing the reliance on physician experience.

3. Solve the pain points of traditional orthopedic surgery: primary hospitals have the ability to perform difficult surgeries.

4. Improve the economic efficiency of hospitals: fundamentally improve the efficiency of patient rotation.

5. Pre-operative positioning, compared to the use of the same size traditional image intensifier shooting, the flat 3D C-shaped arm can present the whole segment of the lumbar spine at once, efficient and accurate.

The alignment technology of Perlove Medical's minimally invasive spine surgery robot uses integrated adaptive alignment technology, which, in layman's terms, means that our scale (i.e., calibration target) is mounted on the C-arm, and by tracking and matching the motion trajectory captured in real time with the preset trajectory, the registration and alignment steps are completed automatically without the limitation of image quality.

Perlove Medical's minimally invasive spine surgery robot is equipped with a 3D C-arm developed and manufactured by Perlove Medical. With the help of integrated adaptive alignment technology, it realizes automatic alignment and registration, and automatically establishes three coordinate associations of optical alignment, patient and image, without manual intervention and accuracy independent of image quality. Then, through the high degree of freedom and stability of the robotic arm operation to complete the path, and intraoperative real-time assessment of completion and important mechanical parameters, to achieve accurate and rationalized orthopedic surgery, improve the success rate of surgery, reduce the incidence of complications and reduce X-ray radiation