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Jung B, Han J, Shahsavarani S, Abbas AM, Echevarria AC, Carrier RE, Ngan A, Katz AD, Essig D, Verma R. Robotic-Assisted Versus Fluoroscopic-Guided Surgery on the Accuracy of Spine Pedicle Screw Placement: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54969. [PMID: 38410625 PMCID: PMC10896625 DOI: 10.7759/cureus.54969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 02/28/2024] Open
Abstract
Spinal fusion is a common method by which surgeons decrease instability and deformity of the spinal segment targeted. Pedicle screws are vital tools in fusion surgeries and advancements in technology have introduced several modalities of screw placement. Our objective was to evaluate the accuracy of pedicle screw placement in robot-assisted (RA) versus fluoroscopic-guided (FG) techniques. The PubMed and Cochrane Library databases were systematically reviewed from January 2007 through to August 8, 2022, to identify relevant studies. The accuracy of pedicle screw placement was determined using the Gertzbein-Robbins (GR) classification system. Facet joint violation (FJV), total case radiation dosage, total case radiation time, total operating room (OR) time, and total case blood loss were collected. Twenty-one articles fulfilled the inclusion criteria. Successful screw accuracy (GR Grade A or B) was found to be 1.02 (95% confidence interval: 1.01 - 1.04) times more likely with the RA technique. In defining accuracy solely based on the GR Grade A criteria, screws placed with RA were 1.10 (95% confidence interval: 1.06 - 1.15) times more likely to be accurate. There was no significant difference between the two techniques with respect to blood loss (Hedges' g: 1.16, 95% confidence interval: -0.75 to 3.06) or case radiation time (Hedges' g: -0.34, 95% CI: -1.22 to 0.53). FG techniques were associated with shorter operating room times (Hedges' g: -1.03, 95% confidence interval: -1.76 to -0.31), and higher case radiation dosage (Hedges' g: 1.61, 95% confidence interval: 1.11 to 2.10). This review suggests that RA may slightly increase pedicle screw accuracy and decrease per-case radiation dosage compared to FG techniques. However, total operating times for RA cases are greater than those for FG cases.
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Affiliation(s)
- Bongseok Jung
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
- Orthopedics, Donald and Barbara Zucker School of Medicine, Hempstead, USA
| | - Justin Han
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | | | - Anas M Abbas
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | | | | | - Alex Ngan
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | - Austen D Katz
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | - David Essig
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | - Rohit Verma
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
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Rehan M, Al-Bahadly I, Thomas DG, Young W, Cheng LK, Avci E. Smart capsules for sensing and sampling the gut: status, challenges and prospects. Gut 2023; 73:186-202. [PMID: 37734912 PMCID: PMC10715516 DOI: 10.1136/gutjnl-2023-329614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/26/2023] [Indexed: 09/23/2023]
Abstract
Smart capsules are developing at a tremendous pace with a promise to become effective clinical tools for the diagnosis and monitoring of gut health. This field emerged in the early 2000s with a successful translation of an endoscopic capsule from laboratory prototype to a commercially viable clinical device. Recently, this field has accelerated and expanded into various domains beyond imaging, including the measurement of gut physiological parameters such as temperature, pH, pressure and gas sensing, and the development of sampling devices for better insight into gut health. In this review, the status of smart capsules for sensing gut parameters is presented to provide a broad picture of these state-of-the-art devices while focusing on the technical and clinical challenges the devices need to overcome to realise their value in clinical settings. Smart capsules are developed to perform sensing operations throughout the length of the gut to better understand the body's response under various conditions. Furthermore, the prospects of such sensing devices are discussed that might help readers, especially health practitioners, to adapt to this inevitable transformation in healthcare. As a compliment to gut sensing smart capsules, significant amount of effort has been put into the development of robotic capsules to collect tissue biopsy and gut microbiota samples to perform in-depth analysis after capsule retrieval which will be a game changer for gut health diagnosis, and this advancement is also covered in this review. The expansion of smart capsules to robotic capsules for gut microbiota collection has opened new avenues for research with a great promise to revolutionise human health diagnosis, monitoring and intervention.
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Affiliation(s)
- Muhammad Rehan
- Department of Electronic Engineering, Sir Syed University of Engineering & Technology, Karachi, Pakistan
| | - Ibrahim Al-Bahadly
- Department of Mechanical and Electrical Engineering, Massey University, Palmerston North, New Zealand
| | - David G Thomas
- School of Agriculture and Environment, Massey University, Palmerston North, New Zealand
| | - Wayne Young
- AgResearch Ltd, Palmerston North, New Zealand
| | - Leo K Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Riddet Institute, Massey University, Palmerston North, New Zealand
| | - Ebubekir Avci
- Department of Mechanical and Electrical Engineering, Massey University, Palmerston North, New Zealand
- The MacDiarmid Institute for Advanced Materials and Nanotechnology, Wellington, New Zealand
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Wang J, Miao J, Zhan Y, Duan Y, Wang Y, Hao D, Wang B. Spine Surgical Robotics: Current Status and Recent Clinical Applications. Neurospine 2023; 20:1256-1271. [PMID: 38171293 PMCID: PMC10762389 DOI: 10.14245/ns.2346610.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 01/05/2024] Open
Abstract
With the development of artificial intelligence and the further deepening of medical-engineering integration, spine surgical robot-assisted (RA) technique has made significant progress and its applicability in clinical practice is constantly expanding in recent years. In this review, we have systematically summarized the majority of literature related to spine surgical robots in the past decade, and not only classified robots accordingly, but also summarized the latest research progress in RA technique for screw placement such as cervical, thoracic, and lumbar pedicle screws, cortical bone trajectory screws, cervical lateral mass screws, and S2 sacroiliac screws; guiding targeted puncture and placement of endoscope via the intervertebral foramen; complete resection of spinal tumor tissue; and decompressive laminectomy. In addition, this report also provides a detailed evaluation of RA technique's advantages and disadvantages, and clarifies the accuracy, safety, and practicality of RA technique. We consider that this review can help clinical physicians further understand and familiarize the current clinical application status of spine surgical robots, thereby promoting the continuous improvement and popularization of RA technique, and ultimately benefiting numerous patients.
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Affiliation(s)
- Jiangtao Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Medical School of Yan’an University, Yan’an, China
| | - Junxian Miao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Shaanxi University of Chinese Medicine, Xi’an, China
| | - Yi Zhan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Shaanxi University of Chinese Medicine, Xi’an, China
| | - Yongchao Duan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Department of Intraoperative Imaging, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yuanshun Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Department of Orthopedics, The Third People’s Hospital of Xining, Qinghai, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Biao Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
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Wang X, Zhu YH, Zhu QS. Efficacy and safety of robot-assisted versus fluoroscopy-assisted PKP or PVP for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. J Robot Surg 2023; 17:2597-2610. [PMID: 37632602 DOI: 10.1007/s11701-023-01700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023]
Abstract
Percutaneous vertebral augmentation (PVA), which includes percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Robot-assisted (RA) and fluoroscopy-assisted (FA) are important methods for treating osteoporotic vertebral compression fractures (OVCFs), though it is still unclear which is superior. This analysis aimed to compare the efficacy and safety of RA and FA. PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure were systematically searched, the outcomes included surgical parameters (leakage rate, operation time, number of fluoroscopic, injection volume, inclination angle), and clinical indexes (hospital stays, Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, the midline height of vertebral). Thirteen articles involving 1094 patients were included. RA group produced better results than the FA group in the leakage rate (OR = 0.27; 95% CI 0.17-0.42; P < 0.00001), number of fluoroscopic (WMD = - 13.88; 95% CI - 18.47 to - 9.30; P < 0.00001), inclination angle (WMD = 5.02; 95% CI 4.42-5.61; P < 0.00001), hospital stays (WMD = - 0.32; 95% CI - 0.58 to - 0.05; P = 0.02), VAS within 3 days (WMD = - 0.19; 95% CI - 0.26 to - 0.12; P < 0.00001), Cobb angle within 3 days (WMD = - 1.35; 95% CI - 2.56 to - 0.14; P = 0.003) and Cobb angle after 1 month (WMD = - 1.02; 95% CI - 1.84 to - 0.20; P = 0.01). But no significant differences in operation time, injection volume, ODI, the midline height of vertebral, and VAS score after 1 month. Our analysis found that the RA group had lower cement leakage rates, number of fluoroscopic and hospital stays, a larger inclination angle, better short-term pain improvement, and Cobb angle improvement. It is worth acknowledging that robotic-assisted surgery holds promise for the development of spine surgery. The study was registered in the PROSPERO (CRD42023393497).
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Affiliation(s)
- Xu Wang
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin, China
| | - Yu-Hang Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin, China.
| | - Qing-San Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin, China.
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Lopez IB, Benzakour A, Mavrogenis A, Benzakour T, Ahmad A, Lemée JM. Robotics in spine surgery: systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2023; 47:447-456. [PMID: 35849162 DOI: 10.1007/s00264-022-05508-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Over 4.83 million spine surgery procedures are performed annually around the world. With the considerable caseload and the precision needed to achieve optimal spinal instrumentation, technical progress has helped to improve the technique's safety and accuracy with the development of peri-operative assistance tools. Contrary to other surgical applications already part of the standard of care, the development of robotics in spine surgery is still a novelty and is not widely available nor used. Robotics, especially when coupled with other guidance modalities such as navigation, seems to be a promising tool in our quest for accuracy, improving patient outcomes and reducing surgical complications. Robotics in spine surgery may also be for the surgeon a way to progress in terms of ergonomics, but also to respond to a growing concern among surgical teams to reduce radiation exposure. METHOD We present in this recent systematic review of the literature realized according to the PRISMA guidelines the place of robotics in spine surgery, reviewing the comparison to standard techniques, the current and future indications, the learning curve, the impact on radiation exposure, and the cost-effectiveness. RESULTS Seventy-six relevant original studies were identified and analyzed for the review. CONCLUSION Robotics has proved to be a safe help for spine surgery, both for the patient with a decrease of operating time and increase in pedicular screw accuracy, and for the surgical team with a decrease of radiation exposure. Medico-economic studies demonstrated that despite a high buying cost, the purchase of a robot dedicated for spine surgery is cost-effective resulting in lesser revision, lower infection, reduced length of stay, and shorter surgical procedure.
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Affiliation(s)
- Ignacio Barrio Lopez
- Department of Neurosurgery, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 09, France
| | - Ahmed Benzakour
- Centre Orléanais du Dos, Pôle Santé Oréliance, Saran, France
| | - Andreas Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Jean-Michel Lemée
- Department of Neurosurgery, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 09, France. .,INSERM CRCI2NA Team 5, GLIAD, Angers, France.
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Cheng QH, Li PB, Lu TT, Guo SF, Di WF, Yang KH, Qian YW. Computer-assisted cannulated screw internal fixation versus conventional cannulated screw internal fixation for femoral neck fractures: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:687. [PMID: 34809649 PMCID: PMC8607593 DOI: 10.1186/s13018-021-02806-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/20/2021] [Indexed: 02/08/2023] Open
Abstract
Objective To compare the effects between computer-assisted and traditional cannulated screw internal fixation on treating femoral neck fracture. Methods The search was conducted in Embase, Pubmed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Database from the beginning to August 2020. RevMan5.4 software, which was provided by the International Cochrane Group, was used for the meta-analysis comparing the differences in operation time, intraoperative bleeding volume, fluoroscopy frequency, fracture healing time, total drilling times, Harris score, fracture healing rate, and femoral head necrosis rate between computer-assisted and traditional methods groups. Results A total of 1028 patients were included in 16 studies. Primary outcome indicators: Compared with the traditional method group, the computer-assisted group had less operative time (2RCTs, P < 0.00001; 8 non-RCTs, P = 0.009; Overall, P < 0.00001), intraoperative bleeding (1 RCTs, P < 0.00001; 9non-RCTs, P < 0.00001; Overall, P < 0.00001), femoral head necrosis rate (1 RCT, P = 0.11;7 non-RCTs, P = 0.09; Overall, P = 0.02) and higher Harris scores (1 RCT, P < 0.0001; 9 non-RCTs, P = 0.0002; Overall, P < 0.0001), and there were no significant differences in fracture healing rate between the two groups (5 non-RCTs, P = 0.17). Secondary outcomes indicators: The computer-assisted group had a lower frequency of intraoperative fluoroscopy and total number of drills compared with the traditional method group, while there was no significant difference in fracture healing time. Conclusion Compared with the traditional hollow screw internal fixation on the treatment of femoral neck fracture, computer-assisted percutaneous cannulated screw fixation can shorten the operation time and improve the operation efficiency and reduce the X-ray injury of medical staff and help patients obtain a better prognosis. Therefore, computer-assisted percutaneous cannulated screw fixation is a better choice for the treatment of femoral neck fracture. Study registration PROSPERO registration number CRD42020214493. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02806-7.
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Affiliation(s)
- Qing-Hao Cheng
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China.,Institution of Clinical Research and Evidence-Based Medicine, The Gansu Provincial Hospital, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000, China.,School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, China
| | - Peng-Biao Li
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Ting-Ting Lu
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China.,Institution of Clinical Research and Evidence-Based Medicine, The Gansu Provincial Hospital, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000, China
| | - Shi-Fang Guo
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Wen-Fei Di
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Ke-Hu Yang
- Institution of Clinical Research and Evidence-Based Medicine, The Gansu Provincial Hospital, Lanzhou, China. .,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000, China. .,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - Yao-Wen Qian
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China.
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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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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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Pennington Z, Morgan CD, Uribe JS. Commentary: Present and Future Spinal Robotic and Enabling Technologies. Oper Neurosurg (Hagerstown) 2021; 21:S57-S58. [PMID: 34128063 DOI: 10.1093/ons/opaa405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Clinton D Morgan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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10
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Lee NJ, Buchanan IA, Boddapati V, Mathew J, Marciano G, Park PJ, Leung E, Buchholz AL, Pollina J, Jazini E, Haines C, Schuler TC, Good CR, Lombardi JM, Lehman RA. Do robot-related complications influence 1 year reoperations and other clinical outcomes after robot-assisted lumbar arthrodesis? A multicenter assessment of 320 patients. J Orthop Surg Res 2021; 16:308. [PMID: 33980261 PMCID: PMC8114480 DOI: 10.1186/s13018-021-02452-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robot-assisted platforms in spine surgery have rapidly developed into an attractive technology for both the surgeon and patient. Although current literature is promising, more clinical data is needed. The purpose of this paper is to determine the effect of robot-related complications on clinical outcomes METHODS: This multicenter study included adult (≥18 years old) patients who underwent robot-assisted lumbar fusion surgery from 2012-2019. The minimum follow-up was 1 year after surgery. Both bivariate and multivariate analyses were performed to determine if robot-related factors were associated with reoperation within 1 year after primary surgery. RESULTS A total of 320 patients were included in this study. The mean (standard deviation) Charlson Comorbidity Index was 1.2 (1.2) and 52.5% of patients were female. Intraoperative robot complications occurred in 3.4% of patients and included intraoperative exchange of screw (0.9%), robot abandonment (2.5%), and return to the operating room for screw exchange (1.3%). The 1-year reoperation rate was 4.4%. Robot factors, including robot time per screw, open vs. percutaneous, and robot system, were not statistically different between those who required revision surgery and those who did not (P>0.05). Patients with robot complications were more likely to have prolonged length of hospital stay and blood transfusion, but were not at higher risk for 1-year reoperations. The most common reasons for reoperation were wound complications (2.2%) and persistent symptoms due to inadequate decompression (1.5%). In the multivariate analysis, robot related factors and complications were not independent risk factors for 1-year reoperations. CONCLUSION This is the largest multicenter study to focus on robot-assisted lumbar fusion outcomes. Our findings demonstrate that 1-year reoperation rates are low and do not appear to be influenced by robot-related factors and complications; however, robot-related complications may increase the risk for greater blood loss requiring a blood transfusion and longer length of stay.
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Affiliation(s)
- Nathan J Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA.
| | - Ian A Buchanan
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Gerard Marciano
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Paul J Park
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Eric Leung
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Avery L Buchholz
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - John Pollina
- Department of Neurosurgery, State University of New York, Buffalo, NY, USA
| | - Ehsan Jazini
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | - Colin Haines
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | - Thomas C Schuler
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | | | - Joseph M Lombardi
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Ronald A Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA
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