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Shuman WH, Valliani AA, Chapman EK, Martini ML, Neifert SN, Baron RB, Schupper AJ, Steinberger JM, Caridi JM. Intraoperative Navigation in Spine Surgery: Effects On Complications and Reoperations. World Neurosurg 2022; 160:e404-e411. [PMID: 35033690 DOI: 10.1016/j.wneu.2022.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/08/2022] [Accepted: 01/08/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Intraoperative navigation during spine surgery improves pedicle screw placement accuracy. However, limited studies have correlated navigation with clinical factors including operative time and safety. This study compares complications and reoperations between surgeries with and without navigation. METHODS Posterior cervical and lumbar fusions and deformity surgeries from 2011-2018 were queried from the NSQIP database and divided by navigation use. Patients aged >89, deformity patients aged <25, and patients undergoing surgery for tumors, fractures, infections, or non-elective indications were excluded. Demographics and perioperative factors were compared with univariate analysis. Outcomes were compared with multivariable logistic regression adjusting for age, sex, BMI, ASA class, surgical region, and multiple levels. Outcomes were also compared stratifying by revision status. RESULTS Navigated surgery patients had higher ASA status (p<0.0001), more multiple-level surgeries (p<0.0001), and longer operations (p<0.0001). Adjusted analysis revealed navigated lumbar surgeries had lower odds of complications (OR=0.82, 95%CI=0.77-0.90, p<0.0001), blood transfusion (OR=0.79, 95%CI=0.72-0.87, p<0.0001), and wound debridement/drainage (OR=0.66, 95%CI=0.44-0.97, p=0.04) compared to non-navigated procedures. Navigated cervical fusions had increased odds of transfusion (OR=1.53, 95%CI=1.06-2.23, p=0.02). Navigated primary fusions had decreased odds of complications (OR=0.91, 95%CI=0.85-0.98, p=0.01); no difference was found in revisions (OR=0.89, 95%CI=0.69-1.14, p=0.34). CONCLUSIONS Navigated surgery patients experienced longer operations due to a combination of time using navigation, more multi-level procedures and larger comorbidity burden, without differences in infections. There were fewer complications and wound washouts in navigated lumbar surgeries due to a higher percentage of minimally invasive cases. Co-utilization of navigation and minimally invasive surgery may benefit properly indicated patients.
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Affiliation(s)
- William H Shuman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States.
| | - Aly A Valliani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Emily K Chapman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Sean N Neifert
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Rebecca B Baron
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Jeremy M Steinberger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - John M Caridi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
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Lee NJ, Buchanan IA, Zuckermann SL, Boddapati V, Mathew J, Geiselmann M, Park PJ, Leung E, Buchholz AL, Khan A, Mullin J, Pollina J, Jazini E, Haines C, Schuler TC, Good CR, Lombardi JM, Lehman RA. What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients. Spine (Phila Pa 1976) 2022; 47:42-48. [PMID: 34091564 PMCID: PMC8654274 DOI: 10.1097/brs.0000000000004132] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter cohort. OBJECTIVE To compare the robot time/screw, radiation exposure, robot abandonment, screw accuracy, and 90-day outcomes between robot-assisted percutaneous and robot-assisted open approach for short lumbar fusion (1- and 2-level). SUMMARY OF BACKGROUND DATA There is conflicting literature on the superiority of robot-assisted minimally invasive spine surgery to open techniques. A large, multicenter study is needed to further elucidate the outcomes and complications between these two approaches. METHODS We included adult patients (≥18 yrs old) who underwent robot-assisted short lumbar fusion surgery from 2015 to 2019 at four independent institutions. A propensity score matching algorithm was employed to control for the potential selection bias between percutaneous and open surgery. The minimum follow-up was 90 days after the index surgery. RESULTS After propensity score matching, 310 patients remained. The mean (standard deviation) Charlson comorbidity index was 1.6 (1.5) and 53% of patients were female. The most common diagnoses included high-grade spondylolisthesis (grade >2) (48%), degenerative disc disease (22%), and spinal stenosis (25%), and the mean number of instrumented levels was 1.5(0.5). The operative time was longer in the open (198 min) versus the percutaneous group (167 min, P value = 0.007). However, the robot time/screw was similar between cohorts (P value > 0.05). The fluoroscopy time/ screw for percutaneous (14.4 s) was longer than the open group (10.1 s, P value = 0.021). The rates for screw exchange and robot abandonment were similar between groups (P value > 0.05). The estimated blood loss (open: 146 mL vs. percutaneous: 61.3 mL, P value < 0.001) and transfusion rate (open: 3.9% vs. percutaneous: 0%, P value = 0.013) were greater for the open group. The 90-day complication rate and mean length of stay were not different between cohorts (P value > 0.05). CONCLUSION Percutaneous robot-assisted spine surgery may increase radiation exposure, but can achieve a shorter operative time and lower risk for intraoperative blood loss for short-lumbar fusion. Percutaneous approaches do not appear to have an advantage for other short-term postoperative outcomes. Future multicenter studies on longer fusion surgeries and the inclusion of patient-reported outcomes are needed.Level of Evidence: 3.
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Affiliation(s)
- Nathan J. Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Ian A. Buchanan
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Scott L. Zuckermann
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Matthew Geiselmann
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY
| | - Paul J. Park
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Eric Leung
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Avery L. Buchholz
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA
| | - Asham Khan
- Department of Neurosurgery, State University of New York, Buffalo, NY
| | - Jeffrey Mullin
- Department of Neurosurgery, State University of New York, Buffalo, NY
| | - John Pollina
- Department of Neurosurgery, State University of New York, Buffalo, NY
| | - Ehsan Jazini
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA
| | - Colin Haines
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA
| | | | | | - Joseph M. Lombardi
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Ronald A. Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
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Patient-Matched 3-D-Printed Guides for the Insertion of Cervical Pedicle Screws in Tumor Surgery. Case Rep Surg 2021; 2021:8135996. [PMID: 34925931 PMCID: PMC8678078 DOI: 10.1155/2021/8135996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Pedicle screw fixation in the cervical spine provides biomechanical advantages compared to other stabilization techniques. However, pedicle screw insertion in this area is challenging due to the anatomical conditions with a high risk of breaching the small pedicles and violating the vertebral artery or neural structures. Today, several techniques to facilitate screw insertion and to make the procedure safer are used. 3-D-printed patient-matched guides based on a CT reconstruction are a helpful technique which allows to reduce operation time and to improve the safety of pedicle screw insertion at the cervical spine. Cases 3-D-printed patient-matched drill guides based on a CT scan with a 3-D reconstruction of the spine were used in two challenging cervical spine surgical tumor cases to facilitate the implantation of the pedicle screws. The screw position was controlled postoperatively by means of the routinely performed CT scan. Results Postoperative imaging (conventional radiographs and CT scan) revealed the correct position of the pedicle screws. The time needed for screw insertion was short, and the need for intraoperative fluoroscopy could be reduced. There was no intra- or postoperative complication related to the pedicle screw implantation. Both tumors could be removed completely. Conclusion These preliminary results show that 3-D-printed patient-specific guides are a promising tool to support and facilitate the implantation of cervical pedicle screws. The time needed for insertion is short, and intraoperative fluoroscopy time can be reduced. This technique allows for both a meticulous preoperative planning and a correct and therefore safe intraoperative positioning of cervical spine pedicle screws.
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Wang TY, Park C, Dalton T, Rajkumar S, McCray E, Owolo E, Than KD, Abd-El-Barr MM. Robotic navigation in spine surgery: Where are we now and where are we going? J Clin Neurosci 2021; 94:298-304. [PMID: 34863454 DOI: 10.1016/j.jocn.2021.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/31/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
Robotic navigation is a new and rapidly emerging niche within minimally invasive spine surgery. The robotic arms-race began in 2004 and has resulted in no less than four major robotic surgical adjuncts. Current Food and Drug Administration (FDA)-approved applications of robotic navigation are limited to pedicle screw instrumentation, but new indications and experimental applications are rapidly emerging. As with any new technology, robotic navigation must be vetted for clinical efficacy, efficiency, safety, and cost-effectiveness. Given the rapid advancements made on a yearly basis, it is important to make frequent and objective assessments of the available technology. Thus, the authors seek to provide the most up-to-date review of the history, currently available technology, learning curve, novel applications, and cost effectiveness of today's available robotic systems as it relates to spine surgery.
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Affiliation(s)
- Timothy Y Wang
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA.
| | | | - Tara Dalton
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Edwin McCray
- School of Medicine, Duke University, Durham, NC, USA
| | - Edwin Owolo
- School of Medicine, Duke University, Durham, NC, USA
| | - Khoi D Than
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA
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Striano BM, Xiong GX, Lightsey HM, Crawford AM, Pisano AJ, Schoenfeld AJ, Simpson AK. Comparison of Radiation Exposure Between Anterior, Lateral, and Posterior Interbody Fusion Techniques and the Influence of Patient and Procedural Factors. Spine (Phila Pa 1976) 2021; 46:1669-1675. [PMID: 34610614 DOI: 10.1097/brs.0000000000004247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The aim of this study was to elucidate the relative influence of multiple factors on radiation usage for anterior, lateral, and posterior based lumbar interbody fusion techniques. SUMMARY OF BACKGROUND DATA There has been substantial global growth in the performance of lumbar interbody fusions, due to evolution of techniques and approaches and increased attention to sagittal alignment. Utilization of intraoperative imaging guidance has similarly expanded, with a predominance of fluoroscopy and consequent increased radiation exposure. There have been no larger-scale studies examining the role of patient and procedural factors in driving radiation exposure across different interbody techniques. METHODS We used a clinical registry to review all single-level lumbar interbody fusions performed between January 2016 and October 2020. Operative records were reviewed for the amount of radiation exposure during the procedure. Patient age, biologic sex, body mass index (BMI), operative surgeon, surgical level, surgical time, and fusion technique were recorded. Multivariable adjusted analyses using negative binomial regression were used to account for confounding. RESULTS We included 134 interbody fusions; 80 performed with a posterior approach (TLIF/PLIF), 43 via an anterior approach (ALIF) with posterior pedicle fixation, and 9 performed with a lateral approach (LLIF/XLIF). Average radiation per case was 136.4 mGy (SE 17.3) for ALIF, 108.6 mGy (16.9) for LLIF/XLIF, and 60.5 mGy (7.4) for TLIF/PLIF. We identified lateral approaches, increased BMI, minimally invasive techniques, and more caudal operative levels as significantly associated with increased radiation exposure. CONCLUSION We identified several novel drivers of radiation exposure during interbody fusion procedures, including the relative importance of technique and the level at which the fusion is performed. More caudal levels of intervention and lateral based techniques had significantly greater radiation exposure.Level of Evidence: 4.
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Affiliation(s)
- Brendan M Striano
- Harvard Combined Orthopedic Residency Program, Harvard Medical School, Boston, M
| | - Grace X Xiong
- Harvard Combined Orthopedic Residency Program, Harvard Medical School, Boston, M
| | - Harry M Lightsey
- Harvard Combined Orthopedic Residency Program, Harvard Medical School, Boston, M
| | - Alexander M Crawford
- Harvard Combined Orthopedic Residency Program, Harvard Medical School, Boston, M
| | - Alfred J Pisano
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew J Schoenfeld
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew K Simpson
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Berlin C, Patel P, Lieberman I, Shaffrey M, Buchholz A. Robotic Sacroiliac Fixation Technique for Triangular Titanium Implant in Adult Degenerative Scoliosis Surgery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E555-E556. [PMID: 34662894 DOI: 10.1093/ons/opab326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/18/2021] [Indexed: 11/14/2022] Open
Abstract
Corrective surgery remains a definitive treatment for adult spinal deformity, improving pain and disability. With these cases, instrumentation to the pelvis with iliac fixation is recommended. Whether iliac or S2-Alar-Iliac (S2AI) trajectories are used, sacroiliac joint pain and long-term sacroilitis can be common after long-fusion constructs.1-3 Sacroiliac fusion with triangular titanium implants during fusion can reduce back pain associated with sacroiliac joint degeneration,3 provides reduction in sacroiliac joint motion and stress when added to S2AI screws, and potentially enhances mechanical stability of fusion constructs.4 Here, we present a technique for placing triangular titanium sacroiliac implants (iFuse BedrockTM; SI-BONE Inc, Santa Clara, California) alongside S2AI screws using a robotic platform (Mazor X; Medtronic Sofamor Danek, Medtronic Inc, Dublin, Ireland). Navigated robotics allows reduction in human error with implant placement, and potentially decreased operative time/fluoroscopy.5-7 Key surgical steps include placement of K wires for S2AI and bilateral SI-implants, tapping, replacing SI-implant K wires with guide pins, placing S2AI screws, and finally placing the SI-implant. Final placement is verified with intraoperative fluoroscopy. The patient described is a 61-yr-old woman with worsening adult degenerative scoliosis, lower back pain, left leg radicular pain, and mild right leg pain who failed conservative treatment. Examination revealed diminished strength in both legs. Imaging was significant for moderate sigmoid scoliosis, discogenic disease, and osteoarthritis at all levels. She consented to undergo corrective surgery. Postoperatively, the patient experienced resolution of her leg weakness and pain. Imaging demonstrated appropriate positioning of hardware. Prospective studies on the efficacy of the SI-implant are underway.
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Affiliation(s)
- Connor Berlin
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Parantap Patel
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | | | - Mark Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Avery Buchholz
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
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Dalton T, Sykes D, Wang TY, Donnelly D, Than KD, Karikari IO, Goodwin CR, Gupta DK, Wiggins WF, Abd-El-Barr MM. Robotic-Assisted Trajectory Into Kambin's Triangle During Percutaneous Transforaminal Lumbar Interbody Fusion-Initial Case Series Investigating Safety and Efficacy. Oper Neurosurg (Hagerstown) 2021; 21:400-408. [PMID: 34624892 DOI: 10.1093/ons/opab325] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Minimally invasive spine surgery (MISS) has the potential to further advance with the use of robot-assisted (RA) techniques. While RA pedicle screw placement has been extensively investigated, there is a lack of literature on the use of the robot for other tasks, such as accessing Kambin's triangle in percutaneous lumbar interbody fusion (percLIF). OBJECTIVE To characterize the surgical feasibility and preliminary outcomes of an initial case series of 10 patients receiving percLIF with RA cage placement via Kambin's triangle. METHODS We performed a single-center, retrospective review of patients undergoing RA percLIF using robot-guided trajectory to access Kambin's triangle for cage placement. Patients undergoing RA percLIF were eligible for enrollment. Baseline health and demographic information in addition to peri- and postoperative data was collected. The dimensions of each patient's Kambin's triangle were measured. RESULTS Ten patients and 11 levels with spondylolisthesis were retrospectively reviewed. All patients successfully underwent the planned procedure without perioperative complications. Four patients underwent their procedure with awake anesthesia. The average dimension of Kambin's triangle was 66.3 m2. With the exception of 1 patient who stayed in the hospital for 7 d, the average length of stay was 1.2 d, with 2 patients discharged the day of surgery. No patients suffered postoperative motor or sensory deficits. Spinopelvic parameters and anterior and posterior disc heights were improved with surgery. CONCLUSION As MISS continues to evolve, further exploration of robot-guided surgical practice, such as our technique, will lead to creative solutions to challenging anatomical variation and overall improved patient care.
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Affiliation(s)
- Tara Dalton
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - David Sykes
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Timothy Y Wang
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Dustin Donnelly
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Khoi D Than
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Isaac O Karikari
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Dhanesh K Gupta
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Walter F Wiggins
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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Epstein NE. Perspective on robotic spine surgery: Who's doing the thinking? Surg Neurol Int 2021; 12:520. [PMID: 34754570 PMCID: PMC8571344 DOI: 10.25259/sni_931_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/04/2022] Open
Abstract
Background Robotic assisted (RA) spine surgery was developed to reduce the morbidity for misplaced thoracolumbar (TL) pedicle screws (PS) resulting in neurovascular injuries, dural fistulas, and/or visceral/other injuries. RA is gaining the attention of spine surgeons to optimize the placement of TL PSs, and to do this more safely/effectively versus utilizing stereotactic navigation alone, or predominantly free hand (FH) techniques. However, little attention is being focused on whether a significant number of these TL RA instrumented fusions are necessary. Methods RA spine surgery has been developed to improve the safety, efficacy, and accuracy of minimally invasive TL versus open FH PS placement. Results Theoretical benefits of RA spine surgery include; enhanced accuracy of screw placement, fewer complications, less radiation exposure, smaller incisions, to minimize blood loss, reduce infection rates, shorten operative times, reduce postoperative recovery periods, and shorten lengths of stay. Cons of RA include; increased cost, increased morbidity with steep learning curves, robotic failures of registration, more soft tissue injuries, lateral skiving of drill guides, displacement of robotic arms impacting accurate PS placement, higher reoperation rates, and potential loss of accuracy with motion versus FH techniques. Notably, insufficient attention has been focused on the necessity for performing many of these TL PS instrumented fusions in the first place. Conclusion RA spinal surgery is still in its infancy, and comparison of RA versus FH techniques for TL PS placement demonstrates several potential pros, but also multiple cons. Further, more attention must be focused on whether many of these TL PS instrumented procedures are even warranted.
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Affiliation(s)
- Nancy E Epstein
- Clinical Professor of Neurological Surgery, School of Medicine, State U. of NY at Stony Brook, NY and ℅ Dr. Marc Agulnick, 1122 Franklin Avenue Suite 106, Garden City, NY 11530, USA
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Cewe P, Vorbau R, Omar A, Elmi-Terander A, Edström E. Radiation distribution in a hybrid operating room, utilizing different X-ray imaging systems: investigations to minimize occupational exposure. J Neurointerv Surg 2021; 14:1139-1144. [PMID: 34750111 PMCID: PMC9606514 DOI: 10.1136/neurintsurg-2021-018220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/31/2021] [Indexed: 01/10/2023]
Abstract
Objectives To reduce occupational radiation exposure in a hybrid operating room (OR) used for three-dimensional (3D) image guided spine procedures. The effects of staff positioning, different X-ray imaging systems, and freestanding radiation protection shields (RPSs) were considered. Methods An anthropomorphic phantom was imaged with a robotic ceiling mounted hybrid OR C-arm cone beam CT (hCBCT), a mobile O-arm CBCT (oCBCT), and a mobile two-dimensional C-arm fluoroscopy system. The resulting scatter doses were measured at different positions in the hybrid OR using active personal dosimeters and an ionization chamber. Two types of RPSs were evaluated. Results Using the hCBCT system instead of the oCBCT system reduced the occupational radiation dose on average by 22%. At 200 cm from the phantom, scatter doses from the hCBCT were 27% lower compared with the oCBCT. One rotational acquisition with hCBCT or oCBCT corresponded to 12 or 16 min of fluoroscopy with the C-arm, respectively. The scatter dose decreased by more than 90% behind an RPS. However, the protection was slightly less effective at 60 cm behind the RPS, due to tertiary scatter from the surroundings. Conclusions For 3D image guided spine procedures in the hybrid OR, occupational radiation exposure is lowered by using hCBCT rather than oCBCT. Radiation exposure can also be decreased by optimal staff positioning in the OR, considering distance to the source and positioning relative to the walls, ceiling, and RPS. In this setting and workflow, staff can use RPSs instead of heavy aprons during intraoperative CBCT imaging, to achieve effective whole body dose reduction with improved comfort.
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Affiliation(s)
- Paulina Cewe
- Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden .,Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Vorbau
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Artur Omar
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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Judy BF, Pennington Z, Botros D, Tsehay Y, Kopparapu S, Liu A, Theodore N, Zakaria HM. Spine Image Guidance and Robotics: Exposure, Education, Training, and the Learning Curve. Int J Spine Surg 2021; 15:S28-S37. [PMID: 34675029 DOI: 10.14444/8138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The use of intraoperative robotics and imaging for spine surgery has been shown to be safe, efficacious, and beneficial to patients, offering accurate placement of instrumentation, decreased operative time and blood loss, and improved postoperative outcomes. Despite these proven benefits, it has yet to be uniformly adopted. One of the major barriers for universal adoption of intraoperative robotics is the learning curve for this complex technology, in conjunction with a lack of formalized training. These same obstacles for universal adoption were faced in the introduction of surgical technology in other disciplines, and the use of this technology has become the standard of care in some of those specialties. Part of the success and widespread implementation of prior novel technology was the introduction of formalized training systems, which are currently lacking in advanced spine surgical technology. Therefore, the future success of intraoperative robotics and imaging for spine surgery depends on the creation of a formalized training system. We detail the best techniques for surgical pedagogy, as well as propose a comprehensive curriculum.
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Affiliation(s)
- Brendan F Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - David Botros
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Yohannes Tsehay
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Srujan Kopparapu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hesham M Zakaria
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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Sommer F, Goldberg JL, McGrath L, Kirnaz S, Medary B, Härtl R. Image Guidance in Spinal Surgery: A Critical Appraisal and Future Directions. Int J Spine Surg 2021; 15:S74-S86. [PMID: 34675032 DOI: 10.14444/8142] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Image-guided spinal surgery (IGSS) underwent rapid development over the past decades. The goal of IGSS is to increase patient safety and improve workflow. We present an overview of the history of IGSS, illustrate its current state, and highlight future developments. Currently, IGSS requires an image set, a tracking system, and a calibration method. IMAGING Two-dimensional images have many disadvantages as a source for navigation. Currently, the most common navigation technique is three-dimensional (3D) navigation based on cross-sectional imaging techniques such as cone-beam computed tomography (CT) or fan-beam CT. TRACKING Electromagnetic tracking uses an electromagnetic field to localize instruments. Optical tracking using infrared cameras has currently become one of the most common tracking methods in IGSS. CALIBRATION The three most common techniques currently used are the point-matching registration technique, the surface-matching registration technique, and the automated registration technique. FUTURE Augmented reality (AR) describes a computer-generated image that can be superimposed onto the real-world environment. Marking pathologies and anatomical landmarks are a few examples of many possible future applications. Additionally, AR offers a wide range of possibilities in surgical training. The latest development in IGSS is robotic-assisted surgery (RAS). The presently available data on RAS are very encouraging, but further improvements of these procedures is expected. CONCLUSION IGSS significantly evolved since its inception and is becoming a routinely used technology. In the future, IGSS will combine the advantages of "active/freehand 3D navigation" with AR and RAS and will one day find its way into all aspects of spinal surgery, not only in instrumented procedures.
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Affiliation(s)
- Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Lynn McGrath
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
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Jin M, Ge M, Lei L, Li F, Wu M, Zhang G, Pei S, Zheng B. Clinical and Radiologic Outcomes of Robot-Assisted Kyphoplasty versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Comparative Study. World Neurosurg 2021; 158:e1-e9. [PMID: 34637939 DOI: 10.1016/j.wneu.2021.10.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Making surgery as less aggressive as possible is best for elderly patients with osteoporotic vertebral compression fractures (OVCFs). Recently, we attempted a more precise, minimally invasive, and robot-assisted kyphoplasty in our clinical setting. OBJECTIVE We sought to compare the clinical and radiologic outcomes of robot-assisted percutaneous kyphoplasty (rPKP) with those of fluoroscopy-assisted percutaneous kyphoplasty (fPKP) in treating OVCFs. METHODS We retrospectively reviewed the clinical and radiologic data of patients with single-segment OVCF who received either rPKP or fPKP between January 2020 and December 2020 at our institution. The operation time, injected volume of cement, length of hospital stays, visual analog scale for back pain, Oswestry Disability Index, local kyphosis angle (LKA), height of fractured vertebra (HFV), and perioperative complications were compared between the 2 groups. RESULTS A total of 212 cases were included in this study, among whom 81 cases received rPKP and 131 cases received fPKP. Both techniques exhibited satisfying improvement in pain relief and radiologic outcomes. Specifically, the rPKP costed less operation time and achieved better correction and maintenance regarding LKA, HFV, and instant pain relief (P < 0.05). The length of hospital stays, incidence of cement leakage, visual analog scale for back pain, and Oswestry Disability Index at final follow-up were comparable between 2 groups. CONCLUSIONS rPKP provides a precise puncture and exhibits superiority in the correction and maintenance of LKA and HFV when compared with traditional fPKP. The cost-effectiveness and specific application scenarios of this technique shall be confirmed via further extensive studies.
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Affiliation(s)
- Mengran Jin
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Meng Ge
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Longyue Lei
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Fengqing Li
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Mujun Wu
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Guang Zhang
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Shaolong Pei
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Biao Zheng
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China.
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Liu A, Jin Y, Cottrill E, Khan M, Westbroek E, Ehresman J, Pennington Z, Lo SFL, Sciubba DM, Molina CA, Witham TF. Clinical accuracy and initial experience with augmented reality-assisted pedicle screw placement: the first 205 screws. J Neurosurg Spine 2021:1-7. [PMID: 34624854 DOI: 10.3171/2021.2.spine202097] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Augmented reality (AR) is a novel technology which, when applied to spine surgery, offers the potential for efficient, safe, and accurate placement of spinal instrumentation. The authors report the accuracy of the first 205 pedicle screws consecutively placed at their institution by using AR assistance with a unique head-mounted display (HMD) navigation system. METHODS A retrospective review was performed of the first 28 consecutive patients who underwent AR-assisted pedicle screw placement in the thoracic, lumbar, and/or sacral spine at the authors' institution. Clinical accuracy for each pedicle screw was graded using the Gertzbein-Robbins scale by an independent neuroradiologist working in a blinded fashion. RESULTS Twenty-eight consecutive patients underwent thoracic, lumbar, or sacral pedicle screw placement with AR assistance. The median age at the time of surgery was 62.5 (IQR 13.8) years and the median body mass index was 31 (IQR 8.6) kg/m2. Indications for surgery included degenerative disease (n = 12, 43%); deformity correction (n = 12, 43%); tumor (n = 3, 11%); and trauma (n = 1, 4%). The majority of patients (n = 26, 93%) presented with low-back pain, 19 (68%) patients presented with radicular leg pain, and 10 (36%) patients had documented lower extremity weakness. A total of 205 screws were consecutively placed, with 112 (55%) placed in the lumbar spine, 67 (33%) in the thoracic spine, and 26 (13%) at S1. Screw placement accuracy was 98.5% for thoracic screws, 97.8% for lumbar/S1 screws, and 98.0% overall. CONCLUSIONS AR depicted through a unique HMD is a novel and clinically accurate technology for the navigated insertion of pedicle screws. The authors describe the first 205 AR-assisted thoracic, lumbar, and sacral pedicle screws consecutively placed at their institution with an accuracy of 98.0% as determined by a Gertzbein-Robbins grade of A or B.
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Affiliation(s)
- Ann Liu
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yike Jin
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ethan Cottrill
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Majid Khan
- 2Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - Erick Westbroek
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeff Ehresman
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zach Pennington
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheng-Fu L Lo
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Camilo A Molina
- 3Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Timothy F Witham
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Patel AV, White CA, Schwartz JT, Pitaro NL, Shah KC, Singh S, Arvind V, Kim JS, Cho SK. Emerging Technologies in the Treatment of Adult Spinal Deformity. Neurospine 2021; 18:417-427. [PMID: 34610669 PMCID: PMC8497255 DOI: 10.14245/ns.2142412.206] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022] Open
Abstract
Outcomes for adult spinal deformity continue to improve as new technologies become integrated into clinical practice. Machine learning, robot-guided spinal surgery, and patient-specific rods are tools that are being used to improve preoperative planning and patient satisfaction. Machine learning can be used to predict complications, readmissions, and generate postoperative radiographs which can be shown to patients to guide discussions about surgery. Robot-guided spinal surgery is a rapidly growing field showing signs of greater accuracy in screw placement during surgery. Patient-specific rods offer improved outcomes through higher correction rates and decreased rates of rod breakage while decreasing operative time. The objective of this review is to evaluate trends in the literature about machine learning, robot-guided spinal surgery, and patient-specific rods in the treatment of adult spinal deformity.
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Affiliation(s)
- Akshar V Patel
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John T Schwartz
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicholas L Pitaro
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kush C Shah
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sirjanhar Singh
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Varun Arvind
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun S Kim
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Devito DP, Woo R. History and Evolution of Spinal Robotics in Pediatric Spinal Deformity. Int J Spine Surg 2021; 15:S65-S73. [PMID: 34675031 PMCID: PMC8532531 DOI: 10.14444/8141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Robotic assistance in surgical procedures is a valuable tool that enhances the safety and efficacy of invasive surgeries. These devices are divided functionally into surgeon surrogates where the device operates under the direct control of an offsite surgeon, and surgeon adjuncts where the device is an intraoperative guidance tool used in a portion of the procedure. The current state of robotic spine surgery focuses on the latter, addressing the primary task of pedicle screw placement. We would like to share our experience with the Mazor Robotics devices to discuss the underlying concepts, strengths, weaknesses, and results as they pertain to pediatric spine deformity.
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Affiliation(s)
- Dennis P. Devito
- Medical Director, Spine Program, Children's Healthcare of Atlanta–Orthopedics and Sports Medicine, Atlanta, Georgia
| | - Raymund Woo
- AdventHealth Medical Group, Orlando, Florida
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Cunningham BW, Brooks DM, McAfee PC. Accuracy of Robotic-Assisted Spinal Surgery-Comparison to TJR Robotics, da Vinci Robotics, and Optoelectronic Laboratory Robotics. Int J Spine Surg 2021; 15:S38-S55. [PMID: 34607917 PMCID: PMC8532535 DOI: 10.14444/8139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The optoelectronic camera source and data interpolation serve as the foundation for navigational integrity in the robotic-assisted surgical platform. The objective of the current systematic review serves to provide a basis for the numerical disparity that exists when comparing the intrinsic accuracy of optoelectronic cameras: accuracy observed in the laboratory setting versus accuracy in the clinical operative environment. It is postulated that there exists a greater number of connections in the optoelectronic kinematic chain when analyzing the clinical operative environment to the laboratory setting. This increase in data interpolation, coupled with intraoperative workflow challenges, reduces the degree of accuracy based on surgical application and to that observed in controlled musculoskeletal kinematic laboratory investigations. METHODS Review of the PubMed and Cochrane Library research databases was performed. The exhaustive literature compilation obtained was then vetted to reduce redundancies and categorized into topics of intrinsic optoelectronic accuracy, registration accuracy, musculoskeletal kinematic platforms, and clinical operative platforms. RESULTS A total of 147 references make up the basis for the current analysis. Regardless of application, the common denominators affecting overall optoelectronic accuracy are intrinsic accuracy, registration accuracy, and application accuracy. Intrinsic accuracy of optoelectronic tracking equaled or was less than 0.1 mm of translation and 0.1° of rotation per fiducial. Controlled laboratory platforms reported 0.1 to 0.5 mm of translation and 0.1°-1.0° of rotation per array. There is a huge falloff in clinical applications: accuracy in robotic-assisted spinal surgery reported 1.5 to 6.0 mm of translation and 1.5° to 5.0° of rotation when comparing planned to final implant position. Total Joint Robotics and da Vinci urologic robotics computed accuracy, as predicted, lies between these two extremes-1.02 mm for da Vinci and 2 mm for MAKO. CONCLUSIONS Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of robotic-assisted spinal surgery. Transitioning from controlled laboratory to clinical operative environments requires an increased number of steps in the optoelectronic kinematic chain and error potential. Diligence in planning, fiducial positioning, system registration, and intraoperative workflow have the potential to improve accuracy and decrease disparity between planned and final implant position. The key determining factors limiting navigation resolution accuracy are highlighted by this Cochrane research analysis.
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Affiliation(s)
- Bryan W. Cunningham
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, D.C
| | - Daina M. Brooks
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Paul C. McAfee
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, D.C
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Wang Y, Cao D, Chen SL, Li YM, Zheng YW, Ohkohchi N. Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery. World J Gastrointest Surg 2021; 13:904-922. [PMID: 34621469 PMCID: PMC8462083 DOI: 10.4240/wjgs.v13.i9.904] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/19/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
With the continuous development of digital medicine, minimally invasive precision and safety have become the primary development trends in hepatobiliary surgery. Due to the specificity and complexity of hepatobiliary surgery, traditional preoperative imaging techniques such as computed tomography and magnetic resonance imaging cannot meet the need for identification of fine anatomical regions. Imaging-based three-dimensional (3D) reconstruction, virtual simulation of surgery and 3D printing optimize the surgical plan through preoperative assessment, improving the controllability and safety of intraoperative operations, and in difficult-to-reach areas of the posterior and superior liver, assistive robots reproduce the surgeon’s natural movements with stable cameras, reducing natural vibrations. Electromagnetic navigation in abdominal surgery solves the problem of conventional surgery still relying on direct visual observation or preoperative image assessment. We summarize and compare these recent trends in digital medical solutions for the future development and refinement of digital medicine in hepatobiliary surgery.
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Affiliation(s)
- Yun Wang
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Di Cao
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Si-Lin Chen
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Yu-Mei Li
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Yun-Wen Zheng
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
- Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, and School of Biotechnology and Heath Sciences, Wuyi University, Jiangmen 529020, Guangdong Province, China
- School of Medicine, Yokohama City University, Yokohama 234-0006, Kanagawa, Japan
| | - Nobuhiro Ohkohchi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
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Spinal metastasis: The rise of minimally invasive surgery. Surgeon 2021; 20:328-333. [PMID: 34563452 DOI: 10.1016/j.surge.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/31/2021] [Accepted: 08/20/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bone is the third most common site of metastatic cancer, of which the spine is the most frequently involved. As metastatic cancer prevalence rises and surgical techniques advance, operative intervention for spinal metastases is expected to rise. In the first operative cohort of spinal metastasis in Ireland, we describe the move towards less invasive surgery, the causative primary types and post-operative survival. METHODS This is a retrospective cohort study of all operative interventions for spinal metastasis in a tertiary referral centre over eight years. Primary spinal tumours and local invasion to the spine were excluded. Median follow up was 1895 days. RESULTS 225 operative procedures in 196 patients with spinal metastasis were performed over eight years. Average cases per year increased form 20 per year to 29 per year. Percutaneous procedures became more common, accounting for the majority (53%) in the final two years. The most common primary types were breast, myeloma, lung, prostate and renal. Overall survival at 1 year was 51%. Primary type was a major determinant of survival, with breast and the haematological cancers demonstrating good survival, while lung had the worst prognosis. CONCLUSION This is the first descriptive cohort of operative interventions for spinal metastasis in an Irish context. Surgery for spinal metastasis is performed at an increasing rate, especially through minimally-invasive means. The majority of patients survive for at least one year post-operatively. Prudent resource planning is necessary to prepare for this growing need.
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Critical analysis for a safe design of 3D printed Patient-Specific Surgical Guides (PSSG) for pedicle screw insertion in spinal deformities. ANNALS OF 3D PRINTED MEDICINE 2021. [DOI: 10.1016/j.stlm.2021.100022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Liounakos JI, Chenin L, Theodore N, Wang MY. Robotics in Spine Surgery and Spine Surgery Training. Oper Neurosurg (Hagerstown) 2021; 21:35-40. [PMID: 34017989 DOI: 10.1093/ons/opaa449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/23/2020] [Indexed: 01/06/2023] Open
Abstract
The increasing interest and advancements in robotic spine surgery parallels a growing emphasis on maximizing patient safety and outcomes. In addition, an increasing interest in minimally invasive spine surgery has further fueled robotic development, as robotic guidance systems are aptly suited for these procedures. This review aims to address 3 of the most critical aspects of robotics in spine surgery today: salient details regarding the current and future development of robotic systems and functionalities, the reported accuracy of implant placement over the years, and how the implementation of robotic systems will impact the training of future generations of spine surgeons. As current systems establish themselves as highly accurate tools for implant placement, the development of novel features, including even robotic-assisted decompression, will likely occur. As spine surgery robots evolve and become increasingly adopted, it is likely that resident and fellow education will follow suit, leading to unique opportunities for both established surgeons and trainees.
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Affiliation(s)
- Jason I Liounakos
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Louis Chenin
- Department of Neurosurgery, Amiens University Hospital, Avenue René Laënnec, Salouël, Amiens Cedex 1, France
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Kelley BV, Hsiue PP, Upfill-Brown AM, Chen CJ, Villalpando C, Lord EL, Shamie AN, Stavrakis AI, Park DY. Utilization trends and outcomes of computer-assisted navigation in spine fusion in the United States. Spine J 2021; 21:1246-1255. [PMID: 33794362 DOI: 10.1016/j.spinee.2021.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Computer-assisted navigation (CAN) has emerged in spine surgery as an approach to improve patient outcomes. While there is substantial evidence demonstrating improved pedicle screw accuracy in CAN as compared to conventional spinal fusion (CONV), there is limited data regarding clinical outcomes and utilization trends in the United States. PURPOSE The purpose of this study was to determine the utilization rates of CAN in the United States, identify patient and hospital trends associated with both techniques, and to compare their results. STUDY DESIGN Retrospective review of national database. PATIENT SAMPLE Nationwide Inpatient Sample (NIS), United States national database. OUTCOME MEASURES CAN utilization, mortality, medical complications, neurologic complications, discharge destination, length of hospital stay, cost of hospital stay. METHODS The NIS database was queried to identify patients undergoing spinal fusion with CAN or CONV. CAN and CONV utilization were tracked by year and anatomic location (cervical, thoracic, lumbar/lumbosacral). Patient demographics, hospital characteristics, index length of stay (LOS), and cost of stay (COS) were compared between the cohorts. After multivariate adjustment, index hospitalization clinical outcomes were compared. RESULTS A total of 4,275,413 patients underwent spinal fusion surgery during the study period (2004 to 2014). CONV was performed in 98.4% (4,208,068) of cases and CAN was performed in 1.6% (67,345) of cases. The utilization rate of CAN increased from 0.04% in 2004 to 3.3% in 2014. Overall, CAN was performed most commonly in the lumbar/lumbosacral region (70.4%) compared to the cervical (20.4%) or thoracic (9.2%) regions. When normalized to region-specific rates of fusion with any technique, the proportional utilization of CAN was highest in the thoracic spine (2.7%), followed by the lumbar/lumbosacral (2.2%) and cervical (0.9%) regions. CAN utilization was positively correlated with patient factors including increasing age and number of medical comorbidities. Multivariate adjusted clinical outcomes demonstrated that compared to CONV, CAN was associated with a statistically significant decreased risk of mortality (0.28% vs 0.31%, OR=0.67, 95% CI: 0.46-0.97, p=.035) and increased risk of blood transfusions (9.1% vs 6.7%, OR=1.19, 95% CI: 1.02-1.39, p=.032). However, there was no difference in risk of neurologic complications. CAN patients had an increased average LOS (4.44 days vs. 3.97 days, p<.0001) and average COS ($34,669.49 vs $26,784.62, p<.0001) compared to CONV patients. CONCLUSIONS CAN utilization increased in the United States from 2004-2014. Use of CAN was proportionately higher in the thoracic and lumbar/lumbosacral regions and in older patients with more comorbidities. Given the continued trend towards increased CAN utilization, large-scale studies are needed to determine the impact of this technology on long-term clinical outcomes.
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Affiliation(s)
- Benjamin V Kelley
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Peter P Hsiue
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Alexander M Upfill-Brown
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Clark J Chen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Cristina Villalpando
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Elizabeth L Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Arya N Shamie
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Alexandra I Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Don Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA.
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Reijers SJM, Heerink WJ, Van Veen R, Nijkamp J, Hoetjes NJ, Schrage Y, Van Akkooi A, Beets GL, Van Coevorden F, Ruers TJM, Groen HC, Van Houdt WJ. Surgical navigation for challenging recurrent or pretreated intra-abdominal and pelvic soft tissue sarcomas. J Surg Oncol 2021; 124:1173-1181. [PMID: 34320228 DOI: 10.1002/jso.26624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/04/2021] [Accepted: 07/09/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND This study assessed whether electromagnetic navigation can be of added value during resection of recurrent or post-therapy intra-abdominal/pelvic soft tissue sarcomas (STS) in challenging locations. MATERIALS AND METHODS Patients were included in a prospective navigation study. A pre-operatively 3D roadmap was made and tracked using electromagnetic reference markers. During the operation, an electromagnetic pointer was used for the localization of the tumor/critical anatomical structures. The primary endpoint was feasibility, secondary outcomes were safety and usability. RESULTS Nine patients with a total of 12 tumors were included, 7 patients with locally recurrent sarcoma. Three patients received neoadjuvant radiotherapy and three other patients received neoadjuvant systemic treatment. The median tumor size was 4.6 cm (2.4-10.4). The majority of distances from tumor to critical anatomical structures was <0.5 cm. The tumors were localized using the navigation system without technical or safety issues. Despite the challenging nature of these resections, 89% were R0 resections, with a median blood loss of 100 ml (20-1050) and one incident of vascular damage. Based on the survey, surgeons stated navigation resulted in shorter surgery time and made the resections easier. CONCLUSION Electromagnetic navigation facilitates resections of challenging lower intra-abdominal/pelvic STS and might be of added value.
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Affiliation(s)
- Sophie J M Reijers
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Wouter J Heerink
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ruben Van Veen
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jasper Nijkamp
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Nikie J Hoetjes
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Yvonne Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Alexander Van Akkooi
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Geerard L Beets
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Frits Van Coevorden
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Theo J M Ruers
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Faculty of Science and Technology (TNW), Nanobiophysics Group, Technical University of Twente, Enschede, The Netherlands
| | - Harald C Groen
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Winan J Van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Massaad E, Shankar GM, Shin JH. Novel Applications of Spinal Navigation in Deformity and Oncology Surgery-Beyond Screw Placement. Oper Neurosurg (Hagerstown) 2021; 21:S23-S38. [PMID: 34128068 DOI: 10.1093/ons/opaa322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 12/30/2022] Open
Abstract
Computer-assisted navigation has made a major impact on spine surgery, providing surgeons with technological tools to safely place instrumentation anywhere in the spinal column. With advances in intraoperative image acquisition, registration, and processing, many surgeons are now using navigation in their practices. The incorporation of navigation into the workflow of surgeons continues to expand with the evolution of minimally invasive techniques and robotic surgery. While numerous investigators have demonstrated the benefit of navigation for improving the accuracy of instrumentation, few have reported applying this technology to other aspects of spine surgery. Surgeries to correct spinal deformities and resect spinal tumors are technically demanding, incorporating a wide range of techniques not only for instrumentation placement but also for osteotomy planning and executing the goals of surgery. Although these subspecialties vary in their objectives, they share similar challenges with potentially high complications, invasiveness, and consequences of failed execution. Herein, we highlight the utility of using spinal navigation for applications beyond screw placement: specifically, for planning and executing osteotomies and guiding the extent of tumor resection. A narrative review of the work that has been done is supplemented with illustrative cases demonstrating these applications.
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Affiliation(s)
- Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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74
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Massaad E, Shankar GM, Shin JH. Commentary: Use of Navigated Ultrasonic Bone Cutting Tool for En Bloc Resection of Thoracic Chondrosarcoma: Technical Report. Oper Neurosurg (Hagerstown) 2021; 20:E163-E164. [PMID: 33269385 DOI: 10.1093/ons/opaa366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/06/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Echt M, Stock A, De la Garza Ramos R, Der E, Hamad M, Holland R, Cezayirli P, Nasser R, Yanamadala V, Yassari R. Separation surgery for metastatic epidural spinal cord compression: comparison of a minimally invasive versus open approach. Neurosurg Focus 2021; 50:E10. [PMID: 33932918 DOI: 10.3171/2021.2.focus201124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to compare outcomes of separation surgery for metastatic epidural spinal cord compression (MESCC) in patients undergoing minimally invasive surgery (MIS) versus open surgery. METHODS A retrospective study of patients undergoing MIS or standard open separation surgery for MESCC between 2009 and 2019 was performed. Both groups received circumferential decompression via laminectomy and a transpedicular approach for partial corpectomy to debulk ventral epidural disease, as well as instrumented stabilization. Outcomes were compared between the two groups. RESULTS There were 17 patients in the MIS group and 24 in the open surgery group. The average age of the MIS group was significantly older than the open surgery group (65.5 vs 56.6 years, p < 0.05). The preoperative Karnofsky Performance Scale score of the open group was significantly lower than that of the MIS group, with averages of 63.0% versus 75.9%, respectively (p = 0.02). This was also evidenced by the higher proportion of emergency procedures performed in the open group (9 of 24 patients vs 0 of 17 patients, p = 0.004). The average Spine Instability Neoplastic Score, number of levels fused, and operative parameters, including length of stay, were similar. The average estimated blood loss difference for the open surgery versus the MIS group (783 mL vs 430 mL, p < 0.05) was significant, although the average amount of packed red blood cells transfused was not significantly different (325 mL vs 216 mL, p = 0.39). Time until start of radiation therapy was slightly less in the MIS than the open surgery group (32.8 ± 15.6 days vs 43.1 ± 20.3 days, p = 0.069). Among patients who underwent open surgery with long-term follow-up, 20% were found to have local recurrence compared with 12.5% of patients treated with the MIS technique. No patients in either group developed hardware failure requiring revision surgery. CONCLUSIONS MIS for MESCC is a safe and effective approach for decompression and stabilization compared with standard open separation surgery, and it significantly reduced blood loss during surgery. Although there was a trend toward a faster time to starting radiation treatment in the MIS group, both groups received similar postoperative radiotherapy doses, with similar rates of local recurrence and hardware failure. An increased ability to perform MIS in emergency settings as well as larger, prospective studies are needed to determine the potential benefits of MIS over standard open separation surgery.
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Affiliation(s)
- Murray Echt
- 1Spine Research Group and.,2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - Ariel Stock
- 1Spine Research Group and.,2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - Rafael De la Garza Ramos
- 1Spine Research Group and.,2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | | | - Mousa Hamad
- 1Spine Research Group and.,2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - Ryan Holland
- 1Spine Research Group and.,2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - Phillip Cezayirli
- 1Spine Research Group and.,2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - Rani Nasser
- 3Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Vijay Yanamadala
- 1Spine Research Group and.,2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - Reza Yassari
- 1Spine Research Group and.,2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
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Rasouli JJ, Shao J, Neifert S, Gibbs WN, Habboub G, Steinmetz MP, Benzel E, Mroz TE. Artificial Intelligence and Robotics in Spine Surgery. Global Spine J 2021; 11:556-564. [PMID: 32875928 PMCID: PMC8119909 DOI: 10.1177/2192568220915718] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES Artificial intelligence (AI) and machine learning (ML) have emerged as disruptive technologies with the potential to drastically affect clinical decision making in spine surgery. AI can enhance the delivery of spine care in several arenas: (1) preoperative patient workup, patient selection, and outcome prediction; (2) quality and reproducibility of spine research; (3) perioperative surgical assistance and data tracking optimization; and (4) intraoperative surgical performance. The purpose of this narrative review is to concisely assemble, analyze, and discuss current trends and applications of AI and ML in conventional and robotic-assisted spine surgery. METHODS We conducted a comprehensive PubMed search of peer-reviewed articles that were published between 2006 and 2019 examining AI, ML, and robotics in spine surgery. Key findings were then compiled and summarized in this review. RESULTS The majority of the published AI literature in spine surgery has focused on predictive analytics and supervised image recognition for radiographic diagnosis. Several investigators have studied the use of AI/ML in the perioperative setting in small patient cohorts; pivotal trials are still pending. CONCLUSIONS Artificial intelligence has tremendous potential in revolutionizing comprehensive spine care. Evidence-based, predictive analytics can help surgeons improve preoperative patient selection, surgical indications, and individualized postoperative care. Robotic-assisted surgery, while still in early stages of development, has the potential to reduce surgeon fatigue and improve technical precision.
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Affiliation(s)
- Jonathan J. Rasouli
- Cleveland Clinic, Cleveland, OH, USA,Jonathan J. Rasouli, Cleveland Clinic,
Center for Spine Health, Desk S40, Cleveland, OH 44195, USA.
| | | | - Sean Neifert
- Icahn School of Medicine at Mount
Sinai, New York, NY, USA
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Lozada-Martínez I, Maiguel-Lapeira J, Torres-Llinás D, Moscote-Salazar L, Rahman MM, Pacheco-Hernández A. Letter: Need and Impact of the Development of Robotic Neurosurgery in Latin America. Neurosurgery 2021; 88:E580-E581. [PMID: 33822187 DOI: 10.1093/neuros/nyab088] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ivan Lozada-Martínez
- Medical and Surgical Research Center School of Medicine University of Cartagena Cartagena, Colombia.,Latinamerican Council of Neurocritical Care (CLaNi) Cartagena, Colombia.,Colombian Clinical Research Group in Neurocritical Care School of Medicine University of Cartagena Cartagena, Colombia
| | - Juan Maiguel-Lapeira
- Medical and Surgical Research Center School of Medicine University of Cartagena Cartagena, Colombia
| | - Daniela Torres-Llinás
- Medical and Surgical Research Center School of Medicine University of Cartagena Cartagena, Colombia
| | - Luis Moscote-Salazar
- Medical and Surgical Research Center School of Medicine University of Cartagena Cartagena, Colombia.,Latinamerican Council of Neurocritical Care (CLaNi) Cartagena, Colombia.,Colombian Clinical Research Group in Neurocritical Care School of Medicine University of Cartagena Cartagena, Colombia
| | - Md Moshiur Rahman
- Neurosurgery Department Holy Family Red Crescent Medical College Dhaka, Bangladesh
| | - Alfonso Pacheco-Hernández
- Medical and Surgical Research Center School of Medicine University of Cartagena Cartagena, Colombia.,Colombian Clinical Research Group in Neurocritical Care School of Medicine University of Cartagena Cartagena, Colombia
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Ansari D, Chiu RG, Kumar M, Patel S, Almadidy Z, Chaudhry NS, Mehta AI. Assessing the Clinical Safety Profile of Computer-Assisted Navigation for Posterior Cervical Fusion: A Propensity-Matched Analysis of 30-Day Outcomes. World Neurosurg 2021; 150:e530-e538. [PMID: 33746104 DOI: 10.1016/j.wneu.2021.03.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Computer-assisted navigation (CAN) has been shown to improve accuracy of screw placement in procedures involving the posterior cervical spine, but whether the addition of CAN affects complication rates, neurologic or otherwise, is presently unknown. The objective of this study is to determine the effect of spinal CAN on short-term clinical outcomes following posterior cervical fusion. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011 to 2018. Patients receiving posterior cervical fusion were identified and separated into CAN and non-CAN cohorts on the basis of a propensity score matching algorithm to select similar patients for comparison. Rates of 30-day unplanned readmission, reoperation, and other complications were evaluated. A separate matching algorithm was used to generate a subgroup of patients undergoing C1-C2 or occiput-C2 fusion for comparison of the same outcomes. RESULTS A total of 12,578 patients met inclusion criteria, of which 689 received CAN and 11,889 did not. After adjusting for baseline differences, patients receiving CAN experienced longer operations and had higher total relative value units associated with care. There were no significant differences in 30-day complication, readmission, or revision rates. At the occipitocervical junction, there were more hardware revisions in the non-CAN group, but this effect did not reach statistical significance (2 vs. 0; P = 0.155). CONCLUSIONS Surgeons should embrace navigation in the cervical spine at their own discretion, as use of CAN does not appear to be associated with increased rates of surgical complications or readmissions despite longer operative time.
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Affiliation(s)
- Darius Ansari
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Megh Kumar
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Zayed Almadidy
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA.
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Evaluation of free-hand screw placement in cervical, thoracic, and lumbar spine by neurosurgical residents. Clin Neurol Neurosurg 2021; 204:106585. [PMID: 33813370 DOI: 10.1016/j.clineuro.2021.106585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/10/2021] [Accepted: 02/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Knowledge of free-hand screw technique remains critical to adequately train neurosurgical residents. The purpose of this study was to evaluate the accuracy of screw placement via the free-hand technique in lumbar, thoracic, and cervical spine by neurosurgical residents completing an enfolded spine fellowship. METHODS Medical records of all patients who underwent free-hand screw placement at all spinal levels over a 6-month period by senior neurosurgical residents enrolled in an in-folded spine fellowship were retrospectively reviewed. Postoperative CT images were assessed for presence and direction of cortical breach. RESULTS Twenty-six patients underwent 162 free-hand screw placements. The most commonly placed screws were cervical lateral mass screws (n = 69), thoracic (n = 41), and lumbar pedicle screws (n = 41). The most common indication for surgery was deformity (n = 22), followed by infection (n = 2) and trauma (n = 2). Fifty-five breaches were identified in 44 (27 %) screws placed in 21 patients (81 %). Anterior breach was identified in 22 cases (40.0 %), lateral in 12 (23.6 %), superior in 7 (12.7 %), and inferior in 7 (12.7 %), and medial in 6 (10.9 %). The most common level of breach was observed in cervical lateral mass screws (n = 19, 43 %) and least common in C2 pars screws (n = 1, 2%). With an average length of follow up of 12.1 ± 7.7 months of follow-up, no clinical sequalae of screw breach was observed. CONCLUSIONS Despite the high prevalence of screw breach using the free-hand technique by neurosurgical residents, the absence of clinical sequelae implies safety and emphasizes the importance of early exposure to this technique during neurosurgical residency training.
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Mallow GM, Siyaji ZK, Galbusera F, Espinoza-Orías AA, Giers M, Lundberg H, Ames C, Karppinen J, Louie PK, Phillips FM, Pourzal R, Schwab J, Sciubba DM, Wang JC, Wilke HJ, Williams FMK, Mohiuddin SA, Makhni MC, Shepard NA, An HS, Samartzis D. Intelligence-Based Spine Care Model: A New Era of Research and Clinical Decision-Making. Global Spine J 2021; 11:135-145. [PMID: 33251858 PMCID: PMC7882816 DOI: 10.1177/2192568220973984] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- G. Michael Mallow
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Zakariah K. Siyaji
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | | | - Alejandro A. Espinoza-Orías
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Morgan Giers
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, OR, USA
| | - Hannah Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco, CA, USA
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Frank M. Phillips
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joseph Schwab
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Daniel M. Sciubba
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Frances M. K. Williams
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | | | - Melvin C. Makhni
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Nicholas A. Shepard
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Howard S. An
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
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81
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Fujiwara Y, Tan Y, Kadiri V, Uotani K, Yamauchi T, Tanaka M. Intraoperative O-arm navigation guided anterior cervical corpectomy and fusion with minimally invasive cervical pedicle screw fixation (MICEPS) for severe ossification of the cervical posterior longitudinal ligament (OPLL): A technical note. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lee SJ, Cho YE, Kim KH, Lee D. Developing a Quantifying Device for Soft Tissue Material Prop-Erties around Lumbar Spines. BIOSENSORS-BASEL 2021; 11:bios11030067. [PMID: 33670989 PMCID: PMC7997198 DOI: 10.3390/bios11030067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022]
Abstract
Knowing the material properties of the musculoskeletal soft tissue could be important to develop rehabilitation therapy and surgical procedures. However, there is a lack of devices and information on the viscoelastic properties of soft tissues around the lumbar spine. The goal of this study was to develop a portable quantifying device for providing strain and stress curves of muscles and ligaments around the lumbar spine at various stretching speeds. Each sample was conditioned and applied for 20 repeatable cyclic 5 mm stretch-and-relax trials in the direction and perpendicular direction of the fiber at 2, 3 and 5 mm/s. Our device successfully provided the stress and strain curve of the samples and our results showed that there were significant effects of speed on the young's modulus of the samples (p < 0.05). Compared to the expensive commercial device, our lower-cost device provided comparable stress and strain curves of the sample. Based on our device and findings, various sizes of samples can be measured and viscoelastic properties of the soft tissues can be obtained. Our portable device and approach can help to investigate young's modulus of musculoskeletal soft tissues conveniently, and can be a basis for developing a material testing device in a surgical room or various lab environments.
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Affiliation(s)
- Song Joo Lee
- Center for Bionics, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul 02792, Korea
- Division of Bio-Medical Science & Technology, Korea Institute of Science and Technolgy (KIST) School, Korea University of Science and Technology, Seoul 02792, Korea
- Correspondence: (S.J.L.); (D.L.); Tel.: +82-2-958-5645 (S.J.L.); +82-2-958-5633 (D.L.)
| | - Yong-Eun Cho
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul 02792, Korea; (Y.-E.C.); (K.-H.K.)
| | - Kyung-Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul 02792, Korea; (Y.-E.C.); (K.-H.K.)
| | - Deukhee Lee
- Division of Bio-Medical Science & Technology, Korea Institute of Science and Technolgy (KIST) School, Korea University of Science and Technology, Seoul 02792, Korea
- Center for Healthcare Robotics, AI and Robot Institute, Korea Institute of Science and Technology, Seoul 02792, Korea
- Correspondence: (S.J.L.); (D.L.); Tel.: +82-2-958-5645 (S.J.L.); +82-2-958-5633 (D.L.)
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Chaker AN, Bhimani AD, Mehta AI. Commentary: Survival Trends After Surgery for Spinal Metastatic Tumors: 20-Year Cancer Center Experience. Neurosurgery 2021; 88:E271-E272. [PMID: 33428756 DOI: 10.1093/neuros/nyaa509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anisse N Chaker
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Abhiraj D Bhimani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
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Zhang X, Uneri A, Wu P, Ketcha MD, Jones CK, Huang Y, Lo SFL, Helm PA, Siewerdsen JH. Long-length tomosynthesis and 3D-2D registration for intraoperative assessment of spine instrumentation. Phys Med Biol 2021; 66:055008. [PMID: 33477120 DOI: 10.1088/1361-6560/abde96] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE A system for long-length intraoperative imaging is reported based on longitudinal motion of an O-arm gantry featuring a multi-slot collimator. We assess the utility of long-length tomosynthesis and the geometric accuracy of 3D image registration for surgical guidance and evaluation of long spinal constructs. METHODS A multi-slot collimator with tilted apertures was integrated into an O-arm system for long-length imaging. The multi-slot projective geometry leads to slight view disparity in both long-length projection images (referred to as 'line scans') and tomosynthesis 'slot reconstructions' produced using a weighted-backprojection method. The radiation dose for long-length imaging was measured, and the utility of long-length, intraoperative tomosynthesis was evaluated in phantom and cadaver studies. Leveraging the depth resolution provided by parallax views, an algorithm for 3D-2D registration of the patient and surgical devices was adapted for registration with line scans and slot reconstructions. Registration performance using single-plane or dual-plane long-length images was evaluated and compared to registration accuracy achieved using standard dual-plane radiographs. RESULTS Longitudinal coverage of ∼50-64 cm was achieved with a single long-length slot scan, providing a field-of-view (FOV) up to (40 × 64) cm2, depending on patient positioning. The dose-area product (reference point air kerma × x-ray field area) for a slot scan ranged from ∼702-1757 mGy·cm2, equivalent to ∼2.5 s of fluoroscopy and comparable to other long-length imaging systems. Long-length scanning produced high-resolution tomosynthesis reconstructions, covering ∼12-16 vertebral levels. 3D image registration using dual-plane slot reconstructions achieved median target registration error (TRE) of 1.2 mm and 0.6° in cadaver studies, outperforming registration to dual-plane line scans (TRE = 2.8 mm and 2.2°) and radiographs (TRE = 2.5 mm and 1.1°). 3D registration using single-plane slot reconstructions leveraged the ∼7-14° angular separation between slots to achieve median TRE ∼2 mm and <2° from a single scan. CONCLUSION The multi-slot configuration provided intraoperative visualization of long spine segments, facilitating target localization, assessment of global spinal alignment, and evaluation of long surgical constructs. 3D-2D registration to long-length tomosynthesis reconstructions yielded a promising means of guidance and verification with accuracy exceeding that of 3D-2D registration to conventional radiographs.
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Affiliation(s)
- Xiaoxuan Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States of America
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MINARO HD: control and evaluation of a handheld, highly dynamic surgical robot. Int J Comput Assist Radiol Surg 2021; 16:467-474. [PMID: 33484430 PMCID: PMC7946686 DOI: 10.1007/s11548-020-02306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022]
Abstract
Purpose Current surgical robotic systems are either large serial arms, resulting in higher risks due to their high inertia and no inherent limitations of the working space, or they are bone-mounted, adding substantial additional task steps to the surgical workflow.
The robot presented in this paper has a handy and lightweight design and can be easily held by the surgeon. No rigid fixation to the bone or a cart is necessary. A high-speed tracking camera together with a fast control system ensures the accurate positioning of a burring tool. Methods The capabilities of the robotic system to dynamically compensate for unintended motion, either of the robot itself or the patient, was evaluated. Therefore, the step response was analyzed as well as the capability to follow a moving target. Results The step response show that the robot can compensate for undesired motions up to 12 Hz in any direction. While following a moving target, a maximum positioning error of 0.5 mm can be obtained with a target motion of up to 18 mm/s. Conclusion The requirements regarding dynamic motion compensation, accuracy, and machining speed of unicompartmental knee arthroplasties, for which the robot was optimized, are achieved with the presented robotic system. In particular, the step response results show that the robot is able to compensate for human tremor.
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86
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Liounakos JI, Kumar V, Jamshidi A, Silman Z, Good CR, Schroerlucke SR, Cannestra A, Hsu V, Lim J, Zahrawi F, Ramirez PM, Sweeney TM, Wang MY. Reduction in complication and revision rates for robotic-guided short-segment lumbar fusion surgery: results of a prospective, multi-center study. J Robot Surg 2021; 15:793-802. [PMID: 33386533 DOI: 10.1007/s11701-020-01165-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022]
Abstract
Studies evaluating robotic guidance in lumbar fusion are limited primarily to evaluation of screw accuracy and perioperative complications. This is the first study to evaluate granular differences in short and long-term complication and revision rate profiles between robotic (RG) fluoroscopic (FG) guidance for minimally invasive short-segment lumbar fusions. A retrospective analysis of a prospective, multi-center database was performed. Complications were subdivided into surgical (further subcategorized into adjacent segment disease, new-onset back pain, radiculopathy, motor-deficit, hardware failure, pseudoarthrosis), wound, and medical complications. Complication and revision rates were compared between RG and FG groups cumulatively at 30, 90 days, and 1 year. 374 RG and 111 FG procedures were performed. RG was associated with an 86.25, 83.20, and 69.42% cumulative reduction in complication rate at 30, 90 days, and 1 year, respectively, compared to FG (p < 0.001). At all follow-up points, new-onset radiculopathy and medical complications were most prevalent in both groups. The greatest reductions in complication rates were seen for new-onset back pain (88.13%; p = 0.001) and wound complications (95.05%; p < 0.001) at 30 days, new-onset motor deficits (90.11%; p = 0.004) and wound complications (85.16%; p < 0.001) at 90 days, and new-onset motor deficits (85.16%; p = 0.002), wound (85.16%; p < 0.001), and medical complications (75.72%; p < 0.001) at 1 year. RG was associated with a 92.58% (p = 0.002) reduction in revision rate at 90 days and a 66.08% (p = 0.026) reduction at 1 year. RG was associated with significant reductions in postoperative complication rates at all follow-up time points and significant reductions in revision rates at 90 days and 1 year.
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Affiliation(s)
- Jason I Liounakos
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, FL, USA.
| | - Vignessh Kumar
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, FL, USA
| | - Aria Jamshidi
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, FL, USA
| | | | | | | | | | - Victor Hsu
- Rothman Institute, Willow Grove, PA, USA
| | - Jae Lim
- Atlantic Brain and Spine, Reston, VA, USA
| | | | | | | | - Michael Y Wang
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, FL, USA
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87
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Huang M, Tetreault TA, Vaishnav A, York PJ, Staub BN. The current state of navigation in robotic spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:86. [PMID: 33553379 PMCID: PMC7859750 DOI: 10.21037/atm-2020-ioi-07] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The advent and widespread adoption of pedicle screw instrumentation prompted the need for image guidance in spine surgery to improve accuracy and safety. Although the conventional method, fluoroscopy, is readily available and inexpensive, concerns regarding radiation exposure and the drive to provide better visual guidance spurred the development of computer-assisted navigation. Contemporaneously, a non-navigated robotic guidance platform was also introduced as a competing modality for pedicle screw placement. Although the robot could provide high precision trajectory guidance by restricting four of the six degrees of freedom (DOF), the lack of real-time depth control and high capital acquisition cost diminished its popularity, while computer-assisted navigation platforms became increasingly sophisticated and accepted. The recent integration of real-time 3D navigation with robotic platforms has resulted in a resurgence of interest in robotics in spine surgery with the recent introduction of numerous navigated robotic platforms. The currently available navigated robotic spine surgery platforms include the ROSA Spine Robot (Zimmer Biomet Robotics formerly Medtech SA, Montpellier, France), ExcelsiusGPS® (Globus Medical, Inc., Audubon, PA, USA), Mazor X spine robot (Medtronic Navigation Louisville, CO; Medtronic Spine, Memphis, TN; formerly Mazor Robotics, Caesarea, Israel) and TiRobot (TINAVI Medical Technologies, Beijing, China). Here we provide an overview of these navigated spine robotic platforms, existing applications, and potential future avenues of implementation.
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Affiliation(s)
- Meng Huang
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Tyler A Tetreault
- Department of Orthopedic Surgery, University of Colorado, Aurora, Colorado, USA
| | - Avani Vaishnav
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Philip J York
- Department of Orthopedic Surgery, University of Colorado, Aurora, Colorado, USA
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88
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Jin M, Lei L, Li F, Zheng B. Does Robot Navigation and Intraoperative Computed Tomography Guidance Help with Percutaneous Endoscopic Lumbar Discectomy? A Match-Paired Study. World Neurosurg 2020; 147:e459-e467. [PMID: 33385595 DOI: 10.1016/j.wneu.2020.12.095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of robot-assisted percutaneous endoscopic lumbar discectomy (rPELD) using a specially designed orthopaedic robot with an intraoperative computed tomography-equipped suite for treatment of symptomatic lumbar disc herniation and compare rPELD with fluoroscopy-assisted percutaneous endoscopic lumbar discectomy (fPELD). METHODS We retrospectively reviewed and compared demographic data, radiologic workups, and patient-reported outcomes of 39 patients treated with rPELD and 78 patients treated with fPELD at our institution between January 2019 and December 2019. RESULTS Our data showed that a single-shot puncture in the rPELD group was significantly more precise compared with 4.12 ± 1.71 trials in the fPELD group (P < 0.001). There was an overall reduction of fluoroscopy (21.33 ± 3.89 times vs. 33.06 ± 2.92 times, P < 0.001), puncture-channel time (13.34 ± 3.03 minutes vs. 15.03 ± 4.5 minutes, P = 0.038), and total operative time (57.46 ± 7.49 minutes vs. 69.40 ± 12.59 minutes, P < 0.001) using the rPELD technique versus the fPELD technique. However, there were no significant differences in patient-reported outcomes, length of hospital stay, and complication rate between the 2 groups (P > 0.05). CONCLUSIONS Taken together, our data indicate that rPELD provides a precise skin entry point and optimal trajectory for puncture, which increases the success rate of PELD, negating the need for revision surgery. However, further studies are required to confirm the superiority and application of the rPELD technique.
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Affiliation(s)
- Mengran Jin
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Longyue Lei
- Department of Orthopaedics, Yuhang Bang Er Hospital, Hangzhou, China
| | - Fengqing Li
- Department of Orthopaedics, Yuhang Bang Er Hospital, Hangzhou, China
| | - Biao Zheng
- Department of Orthopaedics, Yuhang Bang Er Hospital, Hangzhou, China.
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89
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Jamshidi AM, Massel DH, Liounakos JI, Silman Z, Good CR, Schroerlucke SR, Cannestra A, Hsu V, Lim J, Zahrawi F, Ramirez PM, Sweeney TM, Wang MY. Fluoroscopy time analysis of a prospective, multi-centre study comparing robotic- and fluoroscopic-guided placement of percutaneous pedicle screw instrumentation for short segment minimally invasive lumbar fusion surgery. Int J Med Robot 2020; 17:e2188. [PMID: 33217131 DOI: 10.1002/rcs.2188] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/20/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND As minimally invasive spine surgery becomes more widespread, concerns regarding radiation exposure to surgeons and patients alike have become a growing concern. Robotic guidance has been developed as a way to increase the accuracy of instrumentation while decreasing radiation burden. METHODS A retrospective analysis of a large, multi-centre, prospective study comparing robotic-guided (RG) to fluoroscopic-guided (FG) (Multi-centre, Partially Randomized, Controlled Trial of MIS Robotic vs. Freehand in Short Adult Degenerative Spinal Fusion Surgeries) was performed to evaluate for differences in radiation exposure between study groups. RESULTS RG was associated with 78.3% (p < 0.001) and 79.8% (p < 0.001) reduction in total and per screw fluoroscopy times, respectively, as compared to FG. RG was also associated with a 50.8% (p < 0.001) reduction in total operative fluoroscopy time. CONCLUSIONS RG was associated with significantly lower fluoroscopy times compared to FG. This suggests that utilization of robotic navigation systems may result in decreased operative radiation exposure, which is a growing concern for surgeons performing minimally invasive spine surgery.
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Affiliation(s)
- Aria M Jamshidi
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Dustin H Massel
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA.,Department of Orthopedic Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Jason I Liounakos
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Zmira Silman
- Israel Academic College, Tel Aviv University, Ramat Gan, Israel
| | | | | | | | - Victor Hsu
- Rothman Institute, Willow Grove, Pennsylvania, USA
| | - Jae Lim
- Atlantic Brain & Spine, Reston, Viginia, USA
| | - Faissal Zahrawi
- AdventHealth Neuroscience Institute, Celebration, Florida, USA
| | | | | | - Michael Y Wang
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
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90
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Kochanski RB, O'Toole JE. In Reply: Image-Guided Navigation and Robotics in Spine Surgery. Neurosurgery 2020; 87:E722. [PMID: 32945883 DOI: 10.1093/neuros/nyaa410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2000] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
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91
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Zhou LP, Zhang RJ, Sun YW, Zhang L, Shen CL. Accuracy of Pedicle Screw Placement and Four Other Clinical Outcomes of Robotic Guidance Technique versus Computer-Assisted Navigation in Thoracolumbar Surgery: A Meta-Analysis. World Neurosurg 2020; 146:e139-e150. [PMID: 33075574 DOI: 10.1016/j.wneu.2020.10.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Robotic guidance (RG) pedicle screw placement has been increasingly used to improve the rate of insertion accuracy. However, the superiority of the RG technique over computer-assisted navigation (CAN) remains debatable. OBJECTIVE To determine whether the Mazor RG technique is superior to CAN in terms of the rate of insertion accuracy and 4 other clinical indices, namely, intraoperative time, blood loss, complications and revision surgery caused by malposition. METHODS A search of PubMed, Embase, Cochrane, Web of Science, CNKI, and WanFang was conducted. We mainly aimed to evaluate the accuracy of pedicle screw placement between the Mazor RG and CAN techniques. The secondary objectives were intraoperative time, blood loss, complications, and revision surgery caused by malposition. The meta-analysis was conducted using the RevMan 5.3 and Stata 15.1 software. RESULTS A randomized controlled trial and 5 comparative cohort studies consisting of 529 patients and 4081 pedicle screws were included in this meta-analysis. The RG technique has a significantly higher accuracy than CAN in terms of optimal (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.85-2.76; P < 0.01) and clinically acceptable (OR, 1.69; 95% CI, 1.22-2.34; P = 0.002) pedicle screw insertions. Furthermore, the RG technique showed significantly less blood loss (mean difference, -42.49; 95% CI, -78.38 to -6.61; P = 0.02) than did the CAN technique but has equivalent intraoperative time (mean difference, 0.75; 95% CI, -5.89 to 7.40; P = 0.82), complications (OR, 0.65; 95% CI, 0.32-1.33, P = 0.24), and revision surgery caused by malposition (OR, 0.46; 95% CI, 0.15-1.43, P = 0.18). CONCLUSIONS The Mazor RG technique is superior to CAN concerning the accuracy of pedicle screw placement. Thus, the Mazor RG technique is accurate and safe in clinical application.
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Affiliation(s)
- Lu-Ping Zhou
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ren-Jie Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yi-Wei Sun
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lai Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Cai-Liang Shen
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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92
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Park J, Ham DW, Kwon BT, Park SM, Kim HJ, Yeom JS. Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications. Asian Spine J 2020; 14:694-701. [PMID: 33108835 PMCID: PMC7595822 DOI: 10.31616/asj.2020.0384] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022] Open
Abstract
Over the past few decades, interest in minimally invasive spine surgery (MISS) has increased tremendously due to its core principle of minimizing approach-related injury while providing outcomes similar to traditional open spine procedures. With technical and technological advancements, MISS has expanded its utility not only to simple spinal stenosis, but also to complex spinal pathologies such as metastasis, trauma, or adult spinal deformity. In this article, we review the techniques and technology in MISS and discuss the indications, benefits, and limitations of MISS.
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Affiliation(s)
- Jiwon Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dae-Woong Ham
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung-Taek Kwon
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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93
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Sundaram PPM, Oh JYL, Tan M, Nolan CP, Yu CS, Ling JM. Accuracy of Thoracolumbar Pedicle Screw Insertion Based on Routine Use of Intraoperative Imaging and Navigation. Asian Spine J 2020; 15:491-497. [PMID: 32951407 PMCID: PMC8377205 DOI: 10.31616/asj.2020.0068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022] Open
Abstract
Study Design Retrospective review. Purpose To determine the accuracy of thoracolumbar pedicle screw insertion with the routine use of three-dimensional (3D) intraoperative imaging and navigation over a large series of screws in an Asian population. Overview of Literature The use of 3D intraoperative imaging and navigation in spinal surgery is aimed at improving the accuracy of pedicle screw insertion. This study analyzed 2,240 pedicle screws inserted with the routine use of intraoperative navigation. It is one of very few studies done on an Asian population with a large series of screws. Methods Patients who had undergone thoracolumbar pedicle screws insertion using intraoperative imaging and navigation between 2009 and 2017 were retrospectively analyzed. Computed tomography (CT) images acquired after the insertion of pedicle screws were analyzed for breach of the pedicle wall. The pedicle screw breaches were graded according to the Gertzbein classification. The breach rate and revision rate were subsequently calculated. Results A total of 2,240 thoracolumbar pedicle screws inserted under the guidance of intraoperative navigation were analyzed, and the accuracy of the insertion was 97.41%. The overall breach rate was 2.59%, the major breach rate was 0.94%, and the intraoperative screw revision rate was 0.7%. There was no incidence of return to the operating theater for revision of screws. Conclusions The routine use of 3D navigation and intraoperative CT imaging resulted in consistently accurate pedicle screw placement. This improved the safety of spinal instrumentation and helped in avoiding revision surgery for malpositioned screws.
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Affiliation(s)
| | - Jacob Yoong-Leong Oh
- Spine Division, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Mark Tan
- Spine Division, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Chun Sing Yu
- Spine Division, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Ji Min Ling
- Department of Neurosurgery, National Neuroscience Institute, Singapore
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94
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Scalia G, Umana GE, Graziano F, Tomasi SO, Furnari M, Giuffrida M, Ponzo G, Nicoletti GF. Letter: Image-Guided Navigation and Robotics in Spine Surgery. Neurosurgery 2020; 87:E720-E721. [DOI: 10.1093/neuros/nyaa404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gianluca Scalia
- Department of Neurosurgery Highly Specialized Hospital and of National Importance “Garibaldi” Catania, Italy
| | | | - Francesca Graziano
- Department of Neurosurgery Highly Specialized Hospital and of National Importance “Garibaldi” Catania, Italy
- Experimental Biomedicine and Clinical Neurosciences School of Medicine Postgraduate Residency Program in Neurological Surgery Neurosurgical Clinic AOUP “Paolo Giaccone” Palermo, Italy
| | - Santino Ottavio Tomasi
- Department of Neurological Surgery Christian Doppler Klinik Paracelsus Medical University Salzburg, Austria
- Laboratory for Microsurgical Neuroanatomy Christian Doppler Klinik Salzburg, Austria
| | - Massimo Furnari
- Department of Neurosurgery Highly Specialized Hospital and of National Importance “Garibaldi” Catania, Italy
| | - Massimiliano Giuffrida
- Department of Neurosurgery Highly Specialized Hospital and of National Importance “Garibaldi” Catania, Italy
| | - Giancarlo Ponzo
- Department of Neurosurgery Highly Specialized Hospital and of National Importance “Garibaldi” Catania, Italy
| | - Giovanni Federico Nicoletti
- Department of Neurosurgery Highly Specialized Hospital and of National Importance “Garibaldi” Catania, Italy
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95
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Retrospective Review of Revision Surgery After Image-guided Instrumented Spinal Surgery Compared With Traditional Instrumented Spinal Surgery. Clin Spine Surg 2020; 33:E317-E321. [PMID: 32049676 DOI: 10.1097/bsd.0000000000000949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
STUDY DESIGN Retrospective cohort series. OBJECTIVE The objective of this study was to determine if the use of image-guided navigation offers a clinically significant advantage over fluoroscopy-assisted pedicle screw and non-navigated screw placement in reducing the risk of revision surgery for malpositioned screws in instrumented spinal surgery. SUMMARY OF BACKGROUND DATA Use image-guided navigation has become increasingly commonplace in instrumented spine surgery, but there is a lack of information regarding differences in the rates of clinically relevant screw malposition with image-guided compared with non-navigated screw placement. MATERIALS AND METHODS This is a retrospective cohort series of consecutive patients who underwent instrumented spinal surgery by the senior authors at 2 academic tertiary care centers in New York. RESULTS A total of 663 instrumented spinal surgeries were analyzed, including 271 instances with image-guided navigation. For the image-guided navigation cohort, 110 of the patients underwent screw placement using O-Arm image-guidance, yielding data on 1115 screws. The remaining 161 surgeries utilizing image-guided screw placement were performed using Brainlab Spine Navigation, for a total of 1001 screws. A fluoroscopy-assisted technique or freehand technique was used in 419 instances, with a total of 3689 screws. Of the non-navigated cohort, 10 patients required a surgical revision of screw placement, for a total of 15 malpositioned screws. Amongst the image-guided navigation cohort, 1 patient in the O-Arm group and 2 in the Brainlab group required revision surgery, with 3 malpositioned screws in total. The rate of revision surgery for a malpositioned screw placed via non-navigated techniques was 2.39%. This risk was decreased to 1.11% with the use of the intraoperative image-guided navigation. However, no comparisons between non-navigated and image-guided screw placement reached statistical significance. CONCLUSION Although not reaching statistical significance, these data suggest there may be an advantage offered by image-guided screw placement in instrumented spinal surgery.
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96
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Chen X, Feng F, Yu X, Wang S, Tu Z, Han Y, Li Q, Chen H, Chen Z, Lao L, Shen H. Robot-assisted orthopedic surgery in the treatment of adult degenerative scoliosis: a preliminary clinical report. J Orthop Surg Res 2020; 15:282. [PMID: 32711566 PMCID: PMC7382042 DOI: 10.1186/s13018-020-01796-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/14/2020] [Indexed: 11/20/2022] Open
Abstract
Study design A single-institution, retrospective cohort study. Objective To compare the accuracy and short-term clinical outcomes of pedicle screw placement between robot-assisted (RA) and freehand (FH) technique in the treatment of adult degenerative scoliosis (ADS). Methods From February 2018 to October 2019, 97 adult patients with degenerative scoliosis admitted to our department were retrospectively reviewed. Thirty-one patients received robot-assisted pedicle screw placement (RA group), and 66 patients underwent freehand pedicle screw placement (FH group). Patient demographics and short-term clinical outcomes were recorded and compared between two groups. Gertzbein-Robbins grading system was adopted to evaluate the accuracy of pedicle screw placement by means of postoperative CT scan. Short-term clinical outcomes consist of operative time, intraoperative blood loss, length of hospital stay (LOS), radiological parameters, Scoliosis Research Society-22 (SRS-22) scores before the operation, 6 months after operation, adverse events, and revisions. Results The accuracy of screw placement was higher than that of the FH group (clinically acceptable 98.7% vs. 92.2%; P< 0.001). Intraoperative blood loss of the RA group was less than those in the FH group (499 vs. 573 ml; P < 0.001). Operative time (283.1 vs. 291.9 min; P = 0.31) and length of stay (12.8 vs. 13.7 days; P = 0.36) were compared between RA and FH groups. In terms of radiological parameters, both of groups were improved postoperatively. The SRS-22 scores at 6 months after operation from both groups were better than those before operation. For surgery-related complication, one case had pressure sores in the RA group while two cases developed dural tears in the FH group. No revision was required in both groups. Conclusion Combined with other surgical correction modalities, robot-assisted pedicle screw fixation is an effective and safe method of treating degenerative scoliosis. Due to its satisfactory surgical outcomes such as higher accuracy and less trauma, it provides a good alternative for clinical practice. Level of evidence 3.
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Affiliation(s)
- Xiuyuan Chen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China
| | - Fan Feng
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China
| | - Xiaosheng Yu
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China
| | - Shurong Wang
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China
| | - Zhipeng Tu
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China
| | - Yingchao Han
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China
| | - Quan Li
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China
| | - Hao Chen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China
| | - Zhi Chen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China
| | - Lifeng Lao
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China.
| | - Hongxing Shen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China.
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97
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Balicki M, Kyne S, Toporek G, Holthuizen R, Homan R, Popovic A, Burström G, Persson O, Edström E, Elmi-Terander A, Patriciu A. Design and control of an image-guided robot for spine surgery in a hybrid OR. Int J Med Robot 2020; 16:e2108. [PMID: 32270913 DOI: 10.1002/rcs.2108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/17/2020] [Accepted: 03/29/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Minimally invasive spine (MIS) fusion surgery requires image guidance and expert manual dexterity for a successful, efficient, and accurate pedicle screw placement. Operating room (OR)-integrated robotic solution can provide precise assistance to potentially minimize complication rates and facilitate difficult MIS procedures. METHODS A 5-degrees of freedom robot was designed specifically for a hybrid OR with integrated surgical navigation for guiding pedicle screw pilot holes. The system automatically aligns an instrument following the surgical plan using only instrument tracking feedback. Contrary to commercially available robotic systems, no tracking markers on the robotic arm are required. The system was evaluated in a cadaver study. RESULTS The mean targeting error (N = 34) was 1.27±0.57 mm and 1.62±0.85°, with 100% of insertions graded as clinically acceptable. CONCLUSIONS A fully integrated robotic guidance system, including intra-op imaging, planning, and physical guidance with optimized robot design and control, can improve workflow and provide pedicle screw guidance with less than 2 mm targeting error.
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Affiliation(s)
- Marcin Balicki
- Philips Research North America, Cambridge, Massachusetts, USA
| | - Sean Kyne
- Philips Research North America, Cambridge, Massachusetts, USA
| | | | | | | | | | - Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Oscar Persson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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Artificial intelligence in orthopedic surgery: current state and future perspective. Chin Med J (Engl) 2020; 132:2521-2523. [PMID: 31658155 PMCID: PMC6846263 DOI: 10.1097/cm9.0000000000000479] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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99
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Jiang B, Pennington Z, Azad T, Liu A, Ahmed AK, Zygourakis CC, Westbroek EM, Zhu A, Cottrill E, Theodore N. Robot-Assisted versus Freehand Instrumentation in Short-Segment Lumbar Fusion: Experience with Real-Time Image-Guided Spinal Robot. World Neurosurg 2020; 136:e635-e645. [DOI: 10.1016/j.wneu.2020.01.119] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 02/08/2023]
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100
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Vadalà G, De Salvatore S, Ambrosio L, Russo F, Papalia R, Denaro V. Robotic Spine Surgery and Augmented Reality Systems: A State of the Art. Neurospine 2020; 17:88-100. [PMID: 32252158 PMCID: PMC7136092 DOI: 10.14245/ns.2040060.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 12/26/2022] Open
Abstract
Instrumented spine procedures have been performed for decades to treat a wide variety of spinal disorders. New technologies have been employed to obtain a high degree of precision, to minimize risks of damage to neurovascular structures and to diminish harmful exposure of patients and the operative team to ionizing radiations. Robotic spine surgery comprehends 3 major categories: telesurgical robotic systems, robotic-assisted navigation (RAN) and virtual augmented reality (AR) systems, including AR and virtual reality. Telesurgical systems encompass devices that can be operated from a remote command station, allowing to perform surgery via instruments being manipulated by the robot. On the other hand, RAN technologies are characterized by the robotic guidance of surgeon-operated instruments based on real-time imaging. Virtual AR systems are able to show images directly on special visors and screens allowing the surgeon to visualize information about the patient and the procedure (i.e., anatomical landmarks, screw direction and inclination, distance from neurological and vascular structures etc.). The aim of this review is to focus on the current state of the art of robotics and AR in spine surgery and perspectives of these emerging technologies that hold promises for future applications.
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Affiliation(s)
- Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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