Navigation versus Robotik in der Wirbelsäulenchirurgie – Pro Navigation

Zusammenfassung

Ziel dieser Arbeit ist es die Vorteile der spinalen Navigation bei der Platzierung von Implantaten darzulegen verglichen mit der konventionellen Technik, aber insbesondere auch im Vergleich zur robotischen Technik.

Der Einsatz der spinalen Navigation bei Instrumentierungen der Wirbelsäule und des Beckens führt zu einer signifikant geringeren Rate von Schraubenfehllagen, zu einer verbesserten Dimensionierung von Implantaten und zu einer signifikant reduzierten Komplikations- und Revisionsrate.

Weiterhin wird durch den Einsatz der spinalen Navigation die Strahlenbelastung für das an der OP beteiligte Personal signifikant reduziert.

Diese Vorteile sind in vielen wissenschaftlichen Arbeiten publiziert.

Die Verwendung der spinalen Navigation erhöht durch die Anschaffungs- und Wartungskosten, sowie Kosten für notwendige Einmalartikel die Kosten einer Operation.

Trotz der wissenschaftlich nachgewiesenen Vorteile der spinalen Navigation in der Wirbelsäulenchirurgie wird diese weltweit und auch in Deutschland nicht flächendeckend eingesetzt. Aktuell werden in Deutschland nur ca 1/3 aller Pedikelschrauben mit spinaler Navigation implantiert, obwohl die spinale Navigation für den klinischen Einsatz seit 25 Jahren verfügbar ist und klinisch eingesetzt wird.

Eine deutlich weitere Verbreitung ist in Anbetracht der unbestrittenen Vorteile aus medizinischer Sicht unbedingt wünschenswert.

Die seit einigen Jahren verfügbare Robotik ist mittlerweile auch für die Wirbelsäulenchirurgie verfügbar. Sie bietet die gleichen Vorteile wie die spinale Navigation bei jedoch deutlich höheren Anschaffungs- und Unterhaltskosten. Ein signifikanter Vorteil gegenüber der spinalen Navigation für das Platzieren von Implantaten in Hinblick auf Präzision und Effizienz ist bei den aktuell kommerziel verfügbaren Systemen nicht ersichtlich.

Geht man von einem insgesamt gedeckelten Budget aus so wäre aus medizinischer Sicht eine flächendeckendere Verwendung der spinalen Navigation wesentlich effektiver für die Verbesserung der Ergebnisqualität und Patientensicherheit als der zunehmende sehr teure Einsatz der Robotik.

Abstract

The purpose of this work is to outline the advantages of spinal navigation in the placement of implants compared to conventional techniques, and particularly in comparison to robotic techniques.

The use of spinal navigation during instrumentation of the spine and pelvis leads to a significantly lower rate of screw misplacements, improved sizing of implants, and a significantly reduced complication and revision rate. Additionally, the implementation of spinal navigation significantly reduces radiation exposure for the surgical staff involved in the operation.

These advantages have been published in many scientific papers. However, the use of spinal navigation increases the costs of surgery due to acquisition and maintenance costs, as well as the costs of necessary single-use items.

Despite the scientifically proven benefits of spinal navigation in spinal surgery, it is not widely used worldwide, including in Germany. Currently, only about one-third of all pedicle screws in Germany are implanted with spinal navigation, even though spinal navigation has been available for clinical use for 25 years. A significantly wider dissemination is highly desirable, considering the undisputed medical benefits.

Robotics, which has been available for several years, is also now applicable to spinal surgery. It offers the same advantages as spinal navigation but at significantly higher acquisition and maintenance costs. A significant advantage over spinal navigation for the placement of implants is not evident.

If we assume a capped overall budget, from a medical perspective, a more widespread use of spinal navigation would be much more effective in improving outcome quality and patient safety than the increasing very expensive use of robotics.

Schlüsselwörter

Wirbelsäule - spinale Navigation - Computernavigation - Pedikelschrauben - Robotik - Schraubenfehlplatzierung - Komplikationen

Keywords

spine - spinal navigation - computernavigation - pedicle screws - robotics - pedicle screw misplacement - complications

Publikationsverlauf

Artikel online veröffentlicht:
24. Januar 2025

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