Robotic-Assisted Lumbar Fusion: An Effective Technique for Pedicle Screw Placement

Robotic-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion

Instrumentation of the spine has a long history with the advent and eventual evolution of a number of devices, specifically the pedicle screw which is the primary method of instrumenting the thoracolumbar spine. Traditionally, these were placed using anatomical landmarks; however, as technology has advanced, we have seen the integration of fluoroscopy, navigation, and now robotics for assistance. The integration of robotics into spine surgery has led to increased research and industry investment, which continues to push this promising new technology forward. This paper provides an overview of the robotic arm's effects on surgical outcomes, explores the revolutionary technology behind its remarkable performance, and describes its use in minimally invasive transforaminal lumbar interbody fusion which maximizes efficiency.

A novel method to evaluate the transverse pedicle angles of the lower lumbar vertebrae using digital radiography

To investigate a novel approach for establishing the transverse pedicle angle (TPA) of the lower lumbar spine using preoperative digital radiography (DR). Computed Tomography (CT) datasets of the lower lumbar were reconstructed using MIMICS 17.0 software and then imported into 3-matic software for surgical simulation and anatomical parameter measurement. A mathematical algorithm of TPA based on the Pythagorean theorem was established, and all obtained data were analyzed by SPSS software. The CT dataset from 66 samples was reconstructed as a digital model of the lower lumbar vertebrae (L3-L5), and the AP length/estimated lateral length for L3 between the right and left sides was statistically significant (P = 0.015, P = 0.005). The AP length of the right for L4 was smaller than that of the left after a paired t test was executed (P = 0.006). Both the width of the pedicle and the length of the pedicle (P2C1) were consistent with TPA (L3 Collapse

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MESH Headings

• Humans
• Lumbar Vertebrae/diagnostic imaging
• Male
• Tomography, X-Ray Computed/methods
• Female
• Middle Aged
• Adult
• Aged
• Algorithms
• Radiographic Image Enhancement/methods

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Grants

• Social Development Science and Technology Project of Shaanxi Province
• Education Department of Shaanxi Province
• Key Research and Development Projects of Shaanxi Province

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Affiliation(s)

Shixun Wu Department of Orthopedics Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi’an, Shaanxi, China
Shizhang Liu Department of Orthopedics Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi’an, Shaanxi, China
Ming Ling Department of Orthopedics Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi’an, Shaanxi, China
Minggang Huang Department of Computed Tomography, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
Zhe Liu Department of Computed Tomography, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
Xianglong Duan Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi’an, Shaanxi, China Second Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China Institute of Medical Research, Northwestern Polytechnical University, Xi’an Shaanxi, China Second Department of General Surgery, Third Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China

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AR-Supported Supervision of Conditional Autonomous Robots: Considerations for Pedicle Screw Placement in the Future

Robotic assistance is applied in orthopedic interventions for pedicle screw placement (PSP). While current robots do not act autonomously, they are expected to have higher autonomy under surgeon supervision in the mid-term. Augmented reality (AR) is promising to support this supervision and to enable human–robot interaction (HRI). To outline a futuristic scenario for robotic PSP, the current workflow was analyzed through literature review and expert discussion. Based on this, a hypothetical workflow of the intervention was developed, which additionally contains the analysis of the necessary information exchange between human and robot. A video see-through AR prototype was designed and implemented. A robotic arm with an orthopedic drill mock-up simulated the robotic assistance. The AR prototype included a user interface to enable HRI. The interface provides data to facilitate understanding of the robot’s ”intentions”, e.g., patient-specific CT images, the current workflow phase, or the next planned robot motion. Two-dimensional and three-dimensional visualization illustrated patient-specific medical data and the drilling process. The findings of this work contribute a valuable approach in terms of addressing future clinical needs and highlighting the importance of AR support for HRI.

Biomechanical characteristics of 2 different posterior fixation methods of bilateral pedicle screws: A finite element analysis

BACKGROUND

To explore the biomechanical characteristics of 2 posterior bilateral pedicle screw fixation methods using finite element analysis.

METHODS

A normal L3-5 finite element model was established. Based on the verification of its effectiveness, 2 different posterior internal fixation methods were simulated: bilateral pedicle screws (model A) were placed in the L3 and L5 vertebral bodies, and bilateral pedicle screws (model B) were placed in the L3, L4, and L5 vertebral bodies. The stability and stress differences of intervertebral discs, endplates, screws, and rods between models were compared.

RESULTS

Compared with the normal model, the maximum stress of the range of motion, intervertebral disc, and endplate of the 2 models decreased significantly. Under the 6 working conditions, the 2 internal fixation methods have similar effects on the stress of the endplate and intervertebral disc, but the maximum stress of the screws and rods of model B is smaller than that of model A.

CONCLUSIONS

Based on these results, it was found that bilateral pedicle screw fixation in 2 vertebrae L3 and L5 can achieve similar stability as bilateral pedicle screw fixation in 3 vertebrae L3, L4, and L5. However, the maximum stress of the screw and rod in model B is less than that in model A, so this internal fixation method can effectively reduce the risk of fracture. The 3-dimensional finite element model established in this study is in line with the biomechanical characteristics of the spine and can be used for further studies on spinal column biomechanics. This information can serve as a reference for clinicians for surgical selection.