Comparative study of robot-assisted and traditional percutaneous kyphoplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures<bold/>_West China Medical Journal

Authors：

FU Bolin , GONG Dezhi , YANG Sheng , GOU Yongsheng , CHE Zheng , TANG Hongchao ,  ZOU Qiang

Department of Orthopedics, the First People’s Hospital of Shuangliu District / West China (Airport) Hospital Sichuan University, Chengdu, Sichuan 610200, P. R. China;

Corresponding?author：

ZOU Qiang, Email: zouqiang0108@163.com

Keywords：

Robotics; percutaneous kyphoplasty; osteoporotic vertebral compression fracture

DOI：

10.7507/1002-0179.202602037

Video：

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Objective To explore the feasibility of utilizing spinal surgery robots in percutaneous kyphoplasty (PKP). Methods Patients with thoracolumbar osteoporotic vertebral compression fracture (OVCF) who were admitted to the First People’s Hospital of Shuangliu District, Chengdu between June 2022 and June 2024 were selected. The enrolled patients were randomly divided into a robot-assisted group and a manual group in a 1∶1 ratio. The fractured vertebral height, Cobb angle, Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), and complications were compared between the two groups on postoperative day 1 and at 6 months postoperatively. The degree of puncture deviation, bone cement distribution and leakage on postoperative day 1, as well as Odom’s criteria scores at 6 months postoperatively, were also compared between the two groups. Results A total of 130 patients were enrolled, with 65 patients in each group. There was no statistically significant difference (P>0.05) in postoperative height restoration of fractured vertebrae and correction of the Cobb angle between the two groups. Compared with the manual group, the robot-assisted group exhibited shorter operative duration [(32.5±7.3) vs. (35.4±7.1) minutes], fewer intraoperative fluoroscopic exposure times [(20.6±3.4) vs. (22.9±4.5) times], less puncture deviation, a lower bone cement leakage rate (12.3% vs. 26.2%), and more uniform bone cement distribution within vertebral bodies (P<0.05). ODI and VAS scores were significantly improved at postoperative day 1 and 6 months postoperatively compared with preoperative baseline in both groups (P<0.05), yet no intergroup differences were observed at either time point (P>0.05). Odom’s criteria scores at the final follow-up indicated satisfactory overall clinical outcomes for patients in both groups, with no significant intergroup difference (P>0.05). No additional complications were recorded in either group. Conclusion The application of robot-assisted PKP for thoracolumbar OVCF can shorten the operation time, reduce the radiation exposure dose, optimize the distribution of bone cement within the vertebrae, and decrease the risk of leakage.

Citation： FU Bolin, GONG Dezhi, YANG Sheng, GOU Yongsheng, CHE Zheng, TANG Hongchao, ZOU Qiang. Comparative study of robot-assisted and traditional percutaneous kyphoplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures. West China Medical Journal, 2026, 41(7): 1139-1145. doi: 10.7507/1002-0179.202602037 Copy

1.	中國骨質疏松癥流行病學調查及“健康骨骼”專項行動結果發布[J]. 中華骨質疏松和骨礦鹽疾病雜志, 2019, 12(4): 317-318.
2.	Fuggle NR, Curtis EM, Ward KA, et al. Fracture prediction, imaging and screening in osteoporosis[J]. Nat Rev Endocrinol, 2019, 15(9): 535-547.
3.	Al Taha K, Lauper N, Bauer DE, et al. Multidisciplinary and coordinated management of osteoporotic vertebral compression fractures: current state of the art[J]. J Clin Med, 2024, 13(4): 930.
4.	Ong KL, Beall DP, Frohbergh M, et al. Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty "sham" trials?[J]. Osteoporos Int, 2018, 29(2): 375-383.
5.	van der Jagt-Willems HC, Vis M, Tulner CR, et al. Mortality and incident vertebral fractures after 3 years of follow-up among geriatric patients[J]. Osteoporos Int, 2013, 24(5): 1713-1719.
6.	Claren?on F, Fahed R, Gabrieli J, et al. Safety and clinical effectiveness of percutaneous vertebroplasty in the elderly (≥80 years)[J]. Eur Radiol, 2016, 26(7): 2352-2358.
7.	Clark W, Bird P, Gonski P, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial[J]. Lancet, 2016, 388(10052): 1408-1416.
8.	Hinde K, Maingard J, Hirsch JA, et al. Mortality outcomes of vertebral augmentation (vertebroplasty and/or balloon kyphoplasty) for osteoporotic vertebral compression fractures: a systematic review and meta-analysis[J]. Radiology, 2020, 295(1): 96-103.
9.	Wang B, Zhao CP, Song LX, et al. Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review[J]. J Orthop Surg Res, 2018, 13(1): 264.
10.	Huang X, Chang H, Xu H, et al. Comparison of outcomes between percutaneous vertebroplasty and percutaneous kyphoplasty for the treatment of kümmell’s disease: a meta-analysis[J]. Clin Spine Surg, 2022, 35(6): 276-286.
11.	Zhu Y, Cheng J, Yin J, et al. Therapeutic effect of kyphoplasty and balloon vertebroplasty on osteoporotic vertebral compression fracture: a systematic review and meta-analysis of randomized controlled trials[J]. Med (Baltim), 2019, 98(45): e17810.
12.	郭娜, 于曉亮, 胡寧, 等. 一種輔助脊柱微創手術定位系統: CN107361859B[P]. 2024-02-27.
13.	Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo[J]. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
14.	林書, 胡豇, 萬侖, 等. 機器人輔助經皮椎體后凸成形術治療多節段骨質疏松性椎體壓縮性骨折[J]. 中國修復重建外科雜志, 2020, 34(9): 1136-1141.
15.	王翔宇, 譚倫, 林旭, 等. 光電導航引導單側穿刺椎體后凸成形術治療胸腰椎骨質疏松性椎體壓縮骨折[J]. 中國修復重建外科雜志, 2018, 32(2): 203-209.
16.	Li J, Lin J, Yang Y, et al. 3-Dimensional printing guide template assisted percutaneous vertebroplasty: technical note[J]. J Clin Neurosci, 2018, 52: 159-164.
17.	van de Kraats EB, van Walsum T, Verlaan JJ, et al. Three-dimensional rotational X-ray navigation for needle guidance in percutaneous vertebroplasty: an accuracy study[J]. Spine (Phila Pa 1976), 2006, 31(12): 1359-1364.
18.	曹臣, 陳書連, 高延征, 等. 3D 打印輔助經皮椎體成形術治療老年重度骨質疏松性椎體壓縮骨折[J]. 中華創傷雜志, 2018, 34(9): 799-805.
19.	王黎明, 喻忠, 桂鑒超, 等. 計算機導航輔助下經皮椎體成形術[J]. 中華骨科雜志, 2006(10): 676-681.
20.	Zhang Q, Xu YF, Tian W, et al. Comparison of superior-level facet joint violations between robot-assisted percutaneous pedicle screw placement and conventional open fluoroscopic-guided pedicle screw placement[J]. Orthop Surg, 2019, 11(5): 850-856.
21.	Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial[J]. J Neurosurg Spine, 2019, 30(5): 615-622.
22.	袁偉, 孟小童, 劉欣春, 等. 機器人輔助經皮椎體后凸成形術治療單/雙節段骨質疏松性椎體壓縮骨折臨床療效[J]. 中國修復重建外科雜志, 2021, 35(8): 1000-1006.
23.	Ogolo DE, Akwada OR, Ajare EC, et al. Robotic-assisted spine surgery: hype or game-changer?[J]. J Robot Surg, 2025, 19(1): 523.
24.	高鑫峰, 夏韶襁, 趙志剛, 等. 機器人輔助椎弓根外穿刺經皮后凸成形術[J]. 中國矯形外科雜志, 2024, 32(6): 487-492.
25.	姜宇, 李危石, 陳仲強, 等. 直觀圖像定位機器人輔助經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折[J]. 中華骨科雜志, 2024, 44(12): 803-810.
26.	Liu P, Hu J, Zhang W, et al. Robot-assisted versus fluoroscopy-assisted kyphoplasty in treatment of severe osteoporotic vertebral compression fractures in the old patients: a retrospective study: robot-assisted in treatment of severe OVCF[J]. BMC musculoskeletal disorders, 2025, 26(1): 322.
27.	Li Q, Wu C, Huang Z, et al. A comparison of robot-assisted and fluoroscopy-assisted kyphoplasty in the treatment of multi-segmental osteoporotic vertebral compression fractures[J]. J Biomed Res, 2022, 36(3): 208-214.
28.	林書, 譚科, 胡豇, 等. 改良骨科機器人輔助椎體后凸成形術治療骨質疏松性椎體壓縮骨折療效分析[J]. 中國修復重建外科雜志, 2022, 36(9): 1119-1125.
29.	馬銘志, 王志聰, 葉佳徽, 等. “天璣”骨科機器人輔助與徒手經椎弓根行椎體后凸成形術治療胸椎骨質疏松性椎體壓縮骨折的療效分析[J]. 中國修復重建外科雜志, 2023, 37(9): 1106-1112.
30.	Shweikeh F, Amadio JP, Arnell M, et al. Robotics and the spine: a review of current and ongoing applications[J]. Neurosurgical Focus, 2014, 36(3): E10.
31.	王彪, 王江濤, 賀寶榮. 脊柱外科機器人研究現狀及臨床應用展望[J]. 中華醫學雜志, 2024, 104(37): 3471-3477.
32.	Schneider D, Brown EDL, Elsamadicy AA, et al. The hidden cost of robotic spine surgery: real-world adverse events cause 58-minute delays and undermine economic viability[J]. Spine J, 2026, 26(1): 189-198.

1. 中國骨質疏松癥流行病學調查及“健康骨骼”專項行動結果發布[J]. 中華骨質疏松和骨礦鹽疾病雜志, 2019, 12(4): 317-318.
2. Fuggle NR, Curtis EM, Ward KA, et al. Fracture prediction, imaging and screening in osteoporosis[J]. Nat Rev Endocrinol, 2019, 15(9): 535-547.
3. Al Taha K, Lauper N, Bauer DE, et al. Multidisciplinary and coordinated management of osteoporotic vertebral compression fractures: current state of the art[J]. J Clin Med, 2024, 13(4): 930.
4. Ong KL, Beall DP, Frohbergh M, et al. Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty "sham" trials?[J]. Osteoporos Int, 2018, 29(2): 375-383.
5. van der Jagt-Willems HC, Vis M, Tulner CR, et al. Mortality and incident vertebral fractures after 3 years of follow-up among geriatric patients[J]. Osteoporos Int, 2013, 24(5): 1713-1719.
6. Claren?on F, Fahed R, Gabrieli J, et al. Safety and clinical effectiveness of percutaneous vertebroplasty in the elderly (≥80 years)[J]. Eur Radiol, 2016, 26(7): 2352-2358.
7. Clark W, Bird P, Gonski P, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial[J]. Lancet, 2016, 388(10052): 1408-1416.
8. Hinde K, Maingard J, Hirsch JA, et al. Mortality outcomes of vertebral augmentation (vertebroplasty and/or balloon kyphoplasty) for osteoporotic vertebral compression fractures: a systematic review and meta-analysis[J]. Radiology, 2020, 295(1): 96-103.
9. Wang B, Zhao CP, Song LX, et al. Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review[J]. J Orthop Surg Res, 2018, 13(1): 264.
10. Huang X, Chang H, Xu H, et al. Comparison of outcomes between percutaneous vertebroplasty and percutaneous kyphoplasty for the treatment of kümmell’s disease: a meta-analysis[J]. Clin Spine Surg, 2022, 35(6): 276-286.
11. Zhu Y, Cheng J, Yin J, et al. Therapeutic effect of kyphoplasty and balloon vertebroplasty on osteoporotic vertebral compression fracture: a systematic review and meta-analysis of randomized controlled trials[J]. Med (Baltim), 2019, 98(45): e17810.
12. 郭娜, 于曉亮, 胡寧, 等. 一種輔助脊柱微創手術定位系統: CN107361859B[P]. 2024-02-27.
13. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo[J]. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
14. 林書, 胡豇, 萬侖, 等. 機器人輔助經皮椎體后凸成形術治療多節段骨質疏松性椎體壓縮性骨折[J]. 中國修復重建外科雜志, 2020, 34(9): 1136-1141.
15. 王翔宇, 譚倫, 林旭, 等. 光電導航引導單側穿刺椎體后凸成形術治療胸腰椎骨質疏松性椎體壓縮骨折[J]. 中國修復重建外科雜志, 2018, 32(2): 203-209.
16. Li J, Lin J, Yang Y, et al. 3-Dimensional printing guide template assisted percutaneous vertebroplasty: technical note[J]. J Clin Neurosci, 2018, 52: 159-164.
17. van de Kraats EB, van Walsum T, Verlaan JJ, et al. Three-dimensional rotational X-ray navigation for needle guidance in percutaneous vertebroplasty: an accuracy study[J]. Spine (Phila Pa 1976), 2006, 31(12): 1359-1364.
18. 曹臣, 陳書連, 高延征, 等. 3D 打印輔助經皮椎體成形術治療老年重度骨質疏松性椎體壓縮骨折[J]. 中華創傷雜志, 2018, 34(9): 799-805.
19. 王黎明, 喻忠, 桂鑒超, 等. 計算機導航輔助下經皮椎體成形術[J]. 中華骨科雜志, 2006(10): 676-681.
20. Zhang Q, Xu YF, Tian W, et al. Comparison of superior-level facet joint violations between robot-assisted percutaneous pedicle screw placement and conventional open fluoroscopic-guided pedicle screw placement[J]. Orthop Surg, 2019, 11(5): 850-856.
21. Han X, Tian W, Liu Y, et al. Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial[J]. J Neurosurg Spine, 2019, 30(5): 615-622.
22. 袁偉, 孟小童, 劉欣春, 等. 機器人輔助經皮椎體后凸成形術治療單/雙節段骨質疏松性椎體壓縮骨折臨床療效[J]. 中國修復重建外科雜志, 2021, 35(8): 1000-1006.
23. Ogolo DE, Akwada OR, Ajare EC, et al. Robotic-assisted spine surgery: hype or game-changer?[J]. J Robot Surg, 2025, 19(1): 523.
24. 高鑫峰, 夏韶襁, 趙志剛, 等. 機器人輔助椎弓根外穿刺經皮后凸成形術[J]. 中國矯形外科雜志, 2024, 32(6): 487-492.
25. 姜宇, 李危石, 陳仲強, 等. 直觀圖像定位機器人輔助經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折[J]. 中華骨科雜志, 2024, 44(12): 803-810.
26. Liu P, Hu J, Zhang W, et al. Robot-assisted versus fluoroscopy-assisted kyphoplasty in treatment of severe osteoporotic vertebral compression fractures in the old patients: a retrospective study: robot-assisted in treatment of severe OVCF[J]. BMC musculoskeletal disorders, 2025, 26(1): 322.
27. Li Q, Wu C, Huang Z, et al. A comparison of robot-assisted and fluoroscopy-assisted kyphoplasty in the treatment of multi-segmental osteoporotic vertebral compression fractures[J]. J Biomed Res, 2022, 36(3): 208-214.
28. 林書, 譚科, 胡豇, 等. 改良骨科機器人輔助椎體后凸成形術治療骨質疏松性椎體壓縮骨折療效分析[J]. 中國修復重建外科雜志, 2022, 36(9): 1119-1125.
29. 馬銘志, 王志聰, 葉佳徽, 等. “天璣”骨科機器人輔助與徒手經椎弓根行椎體后凸成形術治療胸椎骨質疏松性椎體壓縮骨折的療效分析[J]. 中國修復重建外科雜志, 2023, 37(9): 1106-1112.
30. Shweikeh F, Amadio JP, Arnell M, et al. Robotics and the spine: a review of current and ongoing applications[J]. Neurosurgical Focus, 2014, 36(3): E10.
31. 王彪, 王江濤, 賀寶榮. 脊柱外科機器人研究現狀及臨床應用展望[J]. 中華醫學雜志, 2024, 104(37): 3471-3477.
32. Schneider D, Brown EDL, Elsamadicy AA, et al. The hidden cost of robotic spine surgery: real-world adverse events cause 58-minute delays and undermine economic viability[J]. Spine J, 2026, 26(1): 189-198.

West China Medical Journal

Comparative study of robot-assisted and traditional percutaneous kyphoplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures

Abstract Full text Figures/Tables Video References Cited by

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