With the rapid development of minimally invasive technology, minimally invasive techniques, such as arthroscopy, PTED (percutaneous transforaminal endoscopic discectomy), are widely used in orthopedic surgery. The "percutaneous pedicle screw fixation" (short for PPSF) for the treatment of spinal fractures is becoming more and more mature, bringing well-being to the majority of patients. Recently, Dr. Wang Boyao of the Second Affiliated Hospital of Nanjing Medical University led his medical team to complete a case of PPSF with the assistance of the orthopedic surgery robot produced by Perlove Medical. The operation was successful, and the patient recovered well after the operation with obvious pain relief.

PART 01 Patient Information and Preoperative Examination

Patient Information

Patient's Gender: female

Patient's Age: 48 years old

Patient Condition: Lower back pain for 3 hours caused by trauma

Preoperative Examination

L2 vertebral compression fracture; L4-5 and L5-S1 disc herniation; mild lumbar degeneration

*Preoperative images of the patient

PART 02 The Procedure of Surgical Execution

By using Perlove Medical’s flat panel 3D C-arm, frontal and lateral views of the lesion are taken to determine the exact location of the lumbar spine surgical segment. The sterilization is performed before the surgery. The navigation tracer is installed in the appropriate location, and the 3D images are captured and sent to the robotic navigation system. In the robotic navigation system, the corresponding vertebral body and screw specifications are selected according to the surgical needs, the surgical path is planned, and the surgeon in charge determines the insertion point and angle of pedicle screws.

*Preoperative Planning

After the planning is completed, the robotic arm executes the planning command in place. A guide needle is inserted by the surgeon in charge. After all the guided needles are implanted, the holes are reamed by the reamer following the guided needles and the screws are precisely placed.

*Intraoperative images

PART 03 Postoperative Situation

After completion of pedicle screw placement, the L2 vertebral fracture site was seen on fluoroscopy to return to normal height with minimal intraoperative bleeding and minimal surgical trauma (a total of four incisions of approximately 2 cm).

*Postoperative images

*Minimal surgical trauma

On the second day after surgery, the patient could turn on her own under the guidance of medical staff. And the patient’s pain was significantly relieved and the ability of her activities was significantly improved compared with that before the surgery.

Advantages of the Integrated Whole-process Solution

(Perlove Medical’s Flat Panel 3D C-arm + Orthopedic Surgical Robot)

The flat panel 3D C-arm can present the entire lumbar spine at once. The traditional C-arm makes it difficult to present the full lumbar spine at one time and requires multiple shots. The large 30cm*30cm flat panel eliminates the need for repeated fluoroscopy and saves the surgery time.

Orthopedic surgery robot system can achieve precise positioning and successful puncture at one time. During the puncture process, the caudal inclination of the vertebral body varies less, while the internal inclination varies more, so that a less experienced surgeon may need to repeatedly adjust the direction and angle of the puncture, which can be precisely positioned at once by the robot's intelligent algorithm.

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