Robotic Spine Surgery: Systematic Review of Common Error Types and Best Practices

机器人脊柱手术: 常见错误类型和最佳实践系统综述

Robotic systems have emerged as a significant advancement in the field of spine surgery. They offer improved accuracy in pedicle screw placement and reduce intraoperative complications, hospital length of stay, blood loss, and radiation exposure. As the use of robotics in spine surgery continues to grow, it becomes imperative to understand common errors and challenges associated with this new and promising technology. Although the reported accuracy of robot-assisted pedicle screw placement is very high, the current literature does not capture near misses or incidental procedural errors that might have been managed during surgery or did not alter treatment of patients. We evaluated errors that occur during robot-assisted pedicle screw insertion and identify best practices to minimize their occurrence. On the basis of these findings, we suggest best practices-including close attention to preoperative planning, patient positioning, image registration, and equipment selection-to minimize the occurrence of these errors. Awareness of how errors occur may increase the safety of this technology.

机器人系统已经成为脊柱外科领域的重大进步。它们提高了椎弓根螺钉放置的准确性，并减少了术中并发症，住院时间，失血和辐射暴露。随着机器人技术在脊柱手术中的应用不断增长，了解与这项新的和有前途的技术相关的常见错误和挑战变得势在必行。尽管据报道机器人辅助椎弓根螺钉置入的准确性非常高，但目前的文献并没有捕捉到可能在手术过程中被处理或没有改变患者治疗的近乎失误或偶然的程序错误。我们评估了机器人辅助椎弓根螺钉插入过程中发生的错误，并确定了最佳实践以最大程度地减少其发生。根据这些发现，我们建议最佳实践-包括密切关注术前计划，患者定位，图像配准和设备选择-以最大程度地减少这些错误的发生。意识到错误是如何发生的可能会增加这项技术的安全性。

REF: Gautam D, Vivekanandan S, Mazur MD. Robotic Spine Surgery: Systematic Review of Common Error Types and Best Practices. Oper Neurosurg (Hagerstown). 2025;28(3):295-302. doi:10.1227/ons.0000000000001293 PMID: 39037253

Principles of Stereotactic Surgery

立体定向手术的原则

Stereotactic procedures are used to manage a diverse set of patients across a variety of clinical contexts. The stereotactic devices and software used in these procedures vary between surgeons, but the fundamental principles that constitute safe and accurate execution do not. The aim of this work is to describe these principles to equip readers with a generalizable knowledge base to execute and understand stereotactic procedures. Stereotactic procedures are complex, requiring a thorough understanding of each step of the workflow. The concepts described in this work enable functional neurosurgeons with the fundamental knowledge necessary to provide optimal patient care.

立体定向程序用于在各种临床环境中管理不同组的患者。这些手术中使用的立体定向设备和软件在外科医生之间有所不同，但是构成安全和准确执行的基本原理却没有。这项工作的目的是描述这些原则，为读者提供可概括的知识库，以执行和理解立体定向程序。立体定向程序很复杂，需要对工作流程的每个步骤都有透彻的了解。这项工作中描述的概念使功能神经外科医生具有提供最佳患者护理所需的基本知识。

REF: Jensen MA, Neimat JS, Kerezoudis P, et al. Principles of Stereotactic Surgery. Oper Neurosurg (Hagerstown). 2025;28(3):303-321. doi:10.1227/ons.0000000000001422 PMID: 39627171

A General Framework for Characterizing Inaccuracy in Stereotactic Systems

表征立体定向系统不准确性的通用框架

Identifying and characterizing sources of targeting error in stereotactic procedures is essential to maximizing accuracy, potentially improving surgical outcomes. We aim to describe a generic framework which characterizes sources of stereotactic inaccuracy. This framework provides a rubric to analyze the sources of error for any stereotactic system. Illustrations allow the reader to understand sources of error conceptually so that they may apply them to their practice.

在立体定向程序中识别和表征目标错误的来源对于最大程度地提高准确性，潜在地改善手术效果至关重要。我们旨在描述一个通用框架，该框架表征立体定向不准确性的来源。该框架提供了一个分析任何立体定向系统误差来源的标准。插图使读者能够从概念上理解错误的来源，以便他们可以将其应用于实践。

REF: Jensen MA, Neimat JS, Kerezoudis P, et al. A General Framework for Characterizing Inaccuracy in Stereotactic Systems. Oper Neurosurg (Hagerstown). 2025;28(3):322-336. doi:10.1227/ons.0000000000001423 PMID: 39627169

Hemifacial Spasm Associated With the Specific Offending Vein

与特定的侵犯静脉相关的面肌痉挛

Hemifacial spasm (HFS) caused by venous compression is a rare occurrence. Currently, there is no relevant research on the venous characteristics and potential pathogenic mechanisms causing venous HFS. Exploring the venous characteristics in venous-type HFS may reduce the likelihood of repeated surgery. The study demonstrated that veins can indeed induce HFS. The characteristic of the V. of Mid.Cer.Ped that leads to HFS is that these veins traverse between the facial nerve and the vestibulocochlear nerve, and then surround the ventral aspect of the facial nerve root. The dynamic influence of cerebrospinal fluid leads to pulsatile impingement of the facial nerve on the vein, resulting in facial nerve bending and deformation at the location of the vein. Significantly, in the context of surgery, if it is noticed that the V. of Mid.Cer.Ped surrounds the ventral aspect of the facial nerve root and the facial nerve is compressed and deformed, when AMR disappears after decompression of the artery, it may be necessary to perform vein decompression.

由静脉压迫引起的面肌痉挛 (HFS) 很少见。目前，对引起静脉HFS的静脉特性和潜在致病机制尚无相关研究。探索静脉型HFS的静脉特征可能会减少重复手术的可能性。研究表明，静脉确实可以诱导HFS。导致HFS的Ped的V.的特征是，这些静脉在面神经和前庭蜗神经之间穿行，然后围绕面神经根的腹侧。脑脊液的动态影响导致面神经对静脉的搏动性撞击，导致面神经在静脉位置处弯曲和变形。值得注意的是，在手术的情况下，如果注意到Mid.Cer.Ped的V.围绕面神经的腹侧，面神经受压变形，当动脉减压后AMR消失时，可能需要进行静脉减压。

REF: Cao C, Li M, Wu M, Jiang X. Hemifacial Spasm Associated With the Specific Offending Vein. Oper Neurosurg (Hagerstown). 2025;28(3):337-346. doi:10.1227/ons.0000000000001284 PMID: 38995027

Open Versus Endoscopic Approach for Thoracic Disk Herniations: Equivalent Short-Term Outcomes With Significantly Different Costs

胸椎间盘突出症的开放与内窥镜方法: 具有显着不同成本的等效短期结果

Open thoracic diskectomy often requires significant bone resection and fusion, whereas an endoscopic thoracic diskectomy offers a less invasive alternative. Therefore, we sought to compare one-level open vs endoscopic thoracic diskectomy regarding (1) perioperative outcomes, (2) neurological recovery, and (3) total cost. Endoscopic thoracic diskectomy was associated with decreased length of stay, operative time, blood loss, and total cost compared with the open approach, with similar neurological outcomes. These findings may help patients and surgeons seek endoscopic approach as a less morbid and less costly alternative.

开放式胸椎椎间盘切除术通常需要大量的骨切除和融合，而内窥镜胸椎椎间盘切除术提供了一种侵入性较小的替代方法。因此，我们试图在 (1) 围手术期结果，(2) 神经功能恢复和 (3) 总费用方面比较一级开放和内镜下胸部椎间盘切除术。与开放方法相比，内镜下胸椎间盘切除术可减少住院时间，手术时间，失血量和总费用，神经系统结果相似。这些发现可能有助于患者和外科医生寻求内窥镜检查方法，以减少病态和成本。

REF: Liles C, Chanbour H, Zakieh O, et al. Open Versus Endoscopic Approach for Thoracic Disk Herniations: Equivalent Short-Term Outcomes With Significantly Different Costs. Oper Neurosurg (Hagerstown). 2025;28(3):347-356. doi:10.1227/ons.0000000000001325 PMID: 39189741

Microsurgical Repair of Ventral Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Efficacy and Safety of Patch-Sealing Versus Suturing

自发性低颅压的腹侧脑脊液漏的显微外科修复: 贴片密封与缝合的疗效和安全性

In patients with spontaneous intracranial hypotension (SIH), microsurgical repair is recommended in Type 1 (ventral) dural leaks, when conservative measures fail. However, there is lacking consensus on the optimal surgical technique for permanent and safe closure of ventral leaks. Microsurgical suturing and patch-sealing of ventral dural leaks in patients with SIH are equally effective. Sealing alone is a significantly faster technique, requiring less spinal cord manipulation and may therefore minimize the risk of surgical complications.

对于自发性颅内低血压 (SIH) 患者，当保守措施失败时，建议对1型 (腹侧) 硬脑膜漏进行显微手术修复。然而，对于永久和安全闭合腹侧渗漏的最佳手术技术缺乏共识。SIH患者腹侧硬脑膜漏的显微外科缝合和贴片密封同样有效。单独封闭是一种明显更快的技术，需要较少的脊髓操作，因此可以将手术并发症的风险降至最低。

REF: Petutschnigg T, Häni L, Goldberg J, et al. Microsurgical Repair of Ventral Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Efficacy and Safety of Patch-Sealing Versus Suturing. Oper Neurosurg (Hagerstown). 2025;28(3):379-385. doi:10.1227/ons.0000000000001310 PMID: 39132996

Comparative Analysis of Duroplasty Techniques in Decompressive Craniectomy: The CANDID Study

去骨瓣减压术中椎体成形术技术的比较分析: 坦率的研究

At present, there is no consensus regarding the most optimal dural substitute to use for duroplasty in primary decompressive craniectomy (PDC) for traumatic brain injury (TBI). The author's objective was to conduct a retrospective analysis comparing 2 techniques of PDC: duroplasty using anterior-based vascularized galea pericranium (VP group) with synthetic dural substitute duroplasty (SR group). In this retrospective study, adults who underwent PDC for TBI using anterior-based vascularized galea pericranial graft were associated with better clinical outcomes at 6 months and 1 year compared with standard repair group using synthetic dural substitute (G patch).

目前，对于在原发性去骨瓣减压术 (PDC) 中用于硬脑膜成形术的最佳硬脑膜替代物尚无共识。创伤性脑损伤 (TBI)。作者的目的是进行回顾性分析，比较两种PDC技术: 使用基于前的血管化galea硬脑膜成形术 (VP组) 和合成硬脑膜替代硬脑膜成形术 (SR组)。在这项回顾性研究中，与使用合成硬脑膜替代物 (G补片) 的标准修复组相比，使用基于前部的血管化galea颅骨移植进行PDC治疗TBI的成年人在6个月和1年时具有更好的临床结局。

REF: Ramola M, Ramola M, Singh J, et al. Comparative Analysis of Duroplasty Techniques in Decompressive Craniectomy: The CANDID Study. Oper Neurosurg (Hagerstown). 2025;28(3):357-367. doi:10.1227/ons.0000000000001306 PMID: 39132991

Preliminary Experience With Novel Straight 3-Fr Guiding Sheath for Transradial Access in Endovascular Treatment: Feasibility and Safety

新型直3-Fr导引鞘用于经桡入路血管内治疗的初步经验: 可行性和安全性

Radial artery diameter may limit whether a guiding sheath (GS) can be used via transradial artery access (TRA). A smaller GS may reduce the risk of access site-related complications. This study investigated the feasibility and safety of endovascular treatment (EVT) using a straight-shaped 3-Fr GS (Axcelguide; Medikit). The straight-shaped 3-Fr GS may be applicable for selected pathologies, allowing access even with RAs <2 mm in diameter and facilitating EVT without complications. Preliminary experience with the 3-Fr GS via TRA demonstrated excellent feasibility and safety.

桡动脉直径可以限制引导护套 (GS) 是否可以经由跨桡动脉通路 (TRA) 使用。较小的GS可以降低进入部位相关并发症的风险。这项研究调查了使用直型3-Fr GS (Axcelguide; Medikit) 进行血管内治疗 (EVT) 的可行性和安全性。直形3-Fr GS可能适用于选定的病理，即使在RAs直径 <2毫米的情况下也可以进入，并在无并发症的情况下促进EVT。通过TRA使用3-Fr GS的初步经验证明了出色的可行性和安全性。

REF: Fuga M, Sano T, Hataoka S, et al. Preliminary Experience With Novel Straight 3-Fr Guiding Sheath for Transradial Access in Endovascular Treatment: Feasibility and Safety. Oper Neurosurg (Hagerstown). 2025;28(3):368-378. doi:10.1227/ons.0000000000001307 PMID: 39132995

Minimally Invasive Anterolateral Cervical Cordotomy for Intractable Cancer Pain Using Microtubular Retractors: A Single Institution Case Series

使用微管牵开器的微创前外侧颈部切开术治疗顽固性癌痛: 单机构病例系列

As advancements in cancer treatments have allowed patients with a high burden of disease to live longer, the number of patients who present with debilitating refractory pain has increased. Anterolateral cordotomy has long been used for the treatment of intractable unilateral cancer pain using either an imaging-guided percutaneous approach or an open surgical approach. In this report, we describe a novel minimally invasive modification to the open surgical approach. It combines the benefits of both approaches by providing direct visualization for lesioning without the collateral tissue damage of an open approach. Compared with image-guided percutaneous cordotomy, anterolateral cervical cordotomy with microtubular retractors potentially improves the safety of the procedure through direct visualization while being less invasive than a conventional open approach. Our preliminary experience with this technique demonstrates the feasibility of the approach, as it was both safe and effective.

随着癌症治疗的进步已经允许具有高疾病负担的患者活得更长，呈现使人衰弱的难治性疼痛的患者的数量已经增加。长期以来，使用成像引导的经皮入路或开放式手术入路，将前外侧皮质切开术用于治疗顽固性单侧癌症疼痛。在本报告中，我们描述了对开放手术方法的新型微创修改。它结合了两种方法的优点，提供了直接可视化的损伤，而没有开放方法的附带组织损伤。与图像引导的经皮椎体切开术相比，带有微管牵开器的前外侧颈部椎体切开术通过直接可视化潜在地提高了手术的安全性，同时比传统的开放方法侵入性更小。我们对该技术的初步经验证明了该方法的可行性，因为它既安全又有效。

REF: Kimchi G, Lamsam L, Gu B, et al. Minimally Invasive Anterolateral Cervical Cordotomy for Intractable Cancer Pain Using Microtubular Retractors: A Single Institution Case Series. Oper Neurosurg (Hagerstown). 2025;28(3):386-390. doi:10.1227/ons.0000000000001326 PMID: 39189765