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Nakdhamabhorn S, Pillai BM, Chotivichit A, Suthakorn J. Sensorless Based Haptic Feedback Integration In Robot-assisted Pedicle Screw Insertion For Lumbar Spine Surgery: A preliminary cadaveric study. Comput Struct Biotechnol J 2024; 24:420-433. [PMID: 38841212 PMCID: PMC11152607 DOI: 10.1016/j.csbj.2024.05.022] [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: 10/10/2023] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024] Open
Abstract
Pedicle screw fixation is an essential surgical technique for addressing various spinal pathologies, including degenerative diseases, trauma, tumors, neoplasms, and infections. Despite its efficacy, the procedure poses significant challenges, notably the limited visibility of spinal anatomical landmarks and the consequent reliance on surgeon's hand-eye coordination. These challenges often result in inaccuracies and high radiation exposure due to the frequent use of fluoroscopy X-ray guidance. Addressing these concerns, this study introduces a novel approach to pedicle screw insertion by utilizing a robot-assisted system that incorporates sensorless based haptics incorporated 5-DOF surgical manipulation. This innovative system aims to minimize radiation exposure and reduce operating time while improving the surgeon's hand posture capabilities. The developed prototype, expected to be implemented using bilateral control, was tested through preliminary cadaveric experiments focused on the insertion of both percutaneous and open pedicle screws at the L4-L5 level of the lumbar spine. Validation of the Sensorless Haptic Feedback feature was an integral part of this study, aiming to enhance precision and safety. The results, confirmed by fluoroscopic x-ray images, demonstrated the successful placement of two percutaneous and two open pedicle screws, with average position and torque errors of 0.011 radians and 0.054 Nm for percutaneous screws, and 0.0116 radians and 0.0057 Nm for open screws, respectively. These findings underscore the potential of the sensorless haptic feedback in a robot-assisted pedicle screw insertion system to significantly reduce radiation exposure and improve surgical outcomes, marking a significant advancement in spinal surgery technology.
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Affiliation(s)
- Sakol Nakdhamabhorn
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Branesh M. Pillai
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Areesak Chotivichit
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Jackrit Suthakorn
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
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Gautam D, Vivekanandan S, Mazur MD. Robotic Spine Surgery: Systematic Review of Common Error Types and Best Practices. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01264. [PMID: 39037253 DOI: 10.1227/ons.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/04/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Robotic systems have emerged as a significant advancement in the field of spine surgery. They offer improved accuracy in pedicle screw placement and reduce intraoperative complications, hospital length of stay, blood loss, and radiation exposure. As the use of robotics in spine surgery continues to grow, it becomes imperative to understand common errors and challenges associated with this new and promising technology. Although the reported accuracy of robot-assisted pedicle screw placement is very high, the current literature does not capture near misses or incidental procedural errors that might have been managed during surgery or did not alter treatment of patients. We evaluated errors that occur during robot-assisted pedicle screw insertion and identify best practices to minimize their occurrence. METHODS In this systematic review, we characterized 3 types of errors encountered during robot-assisted pedicle screw insertion-registration errors, skiving, and interference errors-that have been reported in the literature. RESULTS Our search yielded 13 relevant studies reporting robot-assisted screw errors. Nine studies reported registration errors, with 60% of failed screws in those studies caused by registration issues. Seven studies highlighted skiving errors; 26.8% of the failed screws in those studies were caused by skiving. Finally, interference errors were reported in 4 studies, making up 19.5% of failed screws. CONCLUSION On the basis of these findings, we suggest best practices-including close attention to preoperative planning, patient positioning, image registration, and equipment selection-to minimize the occurrence of these errors. Awareness of how errors occur may increase the safety of this technology.
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Affiliation(s)
- Diwas Gautam
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Sheela Vivekanandan
- Neurological Institute, University of Pittsburgh Medical Center, Hershey, Pennsylvania, USA
| | - Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
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Komolafe TE, Zhou L, Zhao W, Guo J, Li Z, Fan Z, Komolafe BF, Wei W, Samuel OW. Advancing robot-guided techniques in lumbar spine surgery: a systematic review and meta-analysis. Expert Rev Med Devices 2024:1-15. [PMID: 39007890 DOI: 10.1080/17434440.2024.2378080] [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: 02/06/2024] [Accepted: 06/04/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Lumbar spine surgery is a crucial intervention for addressing spinal injuries or conditions affecting the spine, often involving lumbar fusion through pedicle screw (PS) insertion. The precision of PS placement is pivotal in orthopedic surgery. This systematic review compares the accuracy of robot-guided (RG) surgery with free-hand fluoroscopy-guided (FFG), free-hand without fluoroscopy-guided (FHG), and computed tomography image-guided (CTG) techniques for PS insertion. METHODS A systematic search of various databases from 1 January 2013 to 30 December 2023 was conducted following PRISMA guidelines. Primary outcomes, including PS insertion accuracy and breach rate, were analyzed using a random-effects model. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS The overall accuracy of PS insertion using RG, based on 37 studies involving 3,837 patients and 22,117 PS, is 97.9%, with a breach rate of 0.021. RG demonstrated superior accuracy compared to FHG and CTG, with breach rates of 3.4 and 0.015 respectively for RG versus FHG, and 3.8 and 0.026 for RG versus CTG. Additionally, RG was associated with reduced mean estimated blood loss compared to CTG, indicating improved safety. CONCLUSIONS The RG is associated with enhanced accuracy of PS insertion and reduced breach rates over other methods. However, additional randomized controlled trials comparing these modalities are needed for further validation. PROSPERO REGISTRATION CRD42023483997.
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Affiliation(s)
| | - Liang Zhou
- Department of Radiology, Jiading District Central Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
- Biomedical Engineering Fusion Laboratory, Jiangning Hospital Affiliated with Nanjing Medical University, Nanjing, China
| | - Wenlong Zhao
- Collaborative Research Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jiachen Guo
- Collaborative Research Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Zongdao Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhiping Fan
- Collaborative Research Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Blessing Funmi Komolafe
- School of International Education, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Wang Wei
- Department of Orthopaedic, School of Medicine, Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
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Sinz NJ, Hwang RW, Lee GH, Baker KC, Arnold P, Sasso R, Park D, Fischgrund J, Niu R, Kim DH. Pedicle Screw-Associated Violation of the Adjacent Unfused Facet Joint: Clinical Outcomes and Fusion Rates. Global Spine J 2024; 14:1477-1484. [PMID: 36510742 DOI: 10.1177/21925682221145651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
STUDY DESIGN Retrospective review of a prospective randomized trial. OBJECTIVES To compare outcome scores and fusion rates in patients with and without pedicle screw-associated facet joint violation (FJV) after a single-level lumbar fusion. METHODS Clinical outcomes data and computed tomography (CT) imaging were reviewed for 157 patients participating in a multicenter prospective trial. Post-operative CT scans at 12-months follow-up were examined for fusion status and FJV. Patient-reported outcomes (PROs) included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for leg and low back pain. Chi-square test of independence was used to compare proportions between groups on categorical measures. Two-sample t-test was used to identify differences in mean patient outcome scores. Logistic regression models were performed to determine association between FJV and fusion rates. RESULTS Of the 157 patients included, there were 18 (11.5%) with FJV (Group A) and 139 (88.5%) without FJV (Group B). Patients with FJV experienced less improvement in ODI (P = .004) and VAS back pain scores (P = .04) vs patients without FJV. There was no difference in mean VAS leg pain (P = .4997). The rate of fusion at 12-months for patients with FJV (27.8%) was lower compared to those without FJV (71.2%) (P = .0002). Patients with FJV were 76% less likely to have a successful fusion at 12-months. CONCLUSION Pedicle screw-associated violation of the adjacent unfused facet joint during single-level lumbar fusion is associated with less improvement in back pain, back pain-associated disability, and a lower fusion rate at 1-year after surgery.
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Affiliation(s)
- Nathan J Sinz
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | - Raymond W Hwang
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Gyu-Ho Lee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin C Baker
- Bone & Joint Center, Dept. of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Paul Arnold
- Carle Neuroscience Institute, Urbana, IL, USA
| | - Rick Sasso
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IL, USA
| | - Daniel Park
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA
| | - Jeffrey Fischgrund
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA
| | - Ruijia Niu
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - David H Kim
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
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Shi C, Tong Y, Harris L, Owusu-Sarpong S, Goldstein J. Proficiency Development and Learning Curve in Robot-Assisted Spine Surgery Using the ExcelsiusGPS® System: Experience From a Single Institution. Global Spine J 2024:21925682241242449. [PMID: 38635306 DOI: 10.1177/21925682241242449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort Study Objectives: Robot-assisted spine surgery (RASS) is a rapidly evolving technique with potential benefits for improving surgical outcomes. A number of studies on RASS learning curve have focused on early iterations of the Mazor robot. Limited research exists on the learning curve associated with using the Globus Medical ExcelsiusGPS® system. In this retrospective study, we aimed to evaluate the learning curve of RASS using the ExcelsiusGPS® system at a single institution. METHODS A total of 95 patients (541 screws) who underwent RASS between 2021 and 2022 were included. Variables including operative time, robot registration time, screw placement time, fluoroscopy utilization, and complications were analyzed. Statistical analysis was performed using descriptive statistics and two-sample t-tests. RESULTS The average operative time significantly decreased after the first 14 cases, indicating a learning curve. However, no significant improvement was observed in robot registration time. Notably, screw placement time significantly improved after approximately 13 cases. When controlling for the number of levels fused, the trends remained consistent. CONCLUSIONS Our study confirmed the presence of a learning curve in RASS using the ExcelsiusGPS® system and demonstrated rapid proficiency development. Our findings highlight the relatively quick learning curve of 1 RASS system.
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Affiliation(s)
- Chen Shi
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Yixuan Tong
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Liam Harris
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - Jeffrey Goldstein
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Kann MR, Ruiz-Cardozo MA, Brehm S, Bui T, Joseph K, Barot K, Trevino G, Carey-Ewend A, Singh SP, De La Paz M, Hanafy A, Olufawo M, Patel RP, Yahanda AT, Perdomo-Pantoja A, Jauregui JJ, Cadieux M, Pennicooke B, Molina CA. Utilization of Augmented Reality Head-Mounted Display for the Surgical Management of Thoracolumbar Spinal Trauma. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:281. [PMID: 38399568 PMCID: PMC10890598 DOI: 10.3390/medicina60020281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Augmented reality head-mounted display (AR-HMD) is a novel technology that provides surgeons with a real-time CT-guided 3-dimensional recapitulation of a patient's spinal anatomy. In this case series, we explore the use of AR-HMD alongside more traditional robotic assistance in surgical spine trauma cases to determine their effect on operative costs and perioperative outcomes. Materials and Methods: We retrospectively reviewed trauma patients who underwent pedicle screw placement surgery guided by AR-HMD or robotic-assisted platforms at an academic tertiary care center between 1 January 2021 and 31 December 2022. Outcome distributions were compared using the Mann-Whitney U test. Results: The AR cohort (n = 9) had a mean age of 66 years, BMI of 29.4 kg/m2, Charlson Comorbidity Index (CCI) of 4.1, and Surgical Invasiveness Index (SII) of 8.8. In total, 77 pedicle screws were placed in this cohort. Intra-operatively, there was a mean blood loss of 378 mL, 0.78 units transfused, 398 min spent in the operating room, and a 20-day LOS. The robotic cohort (n = 13) had a mean age of 56 years, BMI of 27.1 kg/m2, CCI of 3.8, and SII of 14.2. In total, 128 pedicle screws were placed in this cohort. Intra-operatively, there was a mean blood loss of 432 mL, 0.46 units transfused units used, 331 min spent in the operating room, and a 10.4-day LOS. No significant difference was found between the two cohorts in any outcome metrics. Conclusions: Although the need to address urgent spinal conditions poses a significant challenge to the implementation of innovative technologies in spine surgery, this study represents an initial effort to show that AR-HMD can yield comparable outcomes to traditional robotic surgical techniques. Moreover, it highlights the potential for AR-HMD to be readily integrated into Level 1 trauma centers without requiring extensive modifications or adjustments.
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Affiliation(s)
- Michael Ryan Kann
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Miguel A. Ruiz-Cardozo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Tim Bui
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karan Joseph
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karma Barot
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Abigail Carey-Ewend
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Som P. Singh
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Matthew De La Paz
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ahmed Hanafy
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael Olufawo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rujvee P. Patel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alexander T. Yahanda
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alexander Perdomo-Pantoja
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Julio J. Jauregui
- Department of Orthopedic Surgery, University of Maryland Medical System, Baltimore, MD 21201, USA
| | - Magalie Cadieux
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Brenton Pennicooke
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Camilo A. Molina
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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McCormick B, Asdourian PL, Johnson DC, Moatz BW, Duvall GT, Soda MT, Beaufort AR, Chotikul LG, McAfee PC. 100 Complex posterior spinal fusion cases performed with robotic instrumentation. J Robot Surg 2023; 17:2749-2756. [PMID: 37707742 DOI: 10.1007/s11701-023-01707-7] [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: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023]
Abstract
Robotic navigation has been shown to increase precision, accuracy, and safety during spinal reconstructive procedures. There is a paucity of literature describing the best techniques for robotic-assisted spine surgery for complex, multilevel cases or in cases of significant deformity correction. We present a case series of 100 consecutive multilevel posterior spinal fusion procedures performed for multilevel spinal disease and/or deformity correction. 100 consecutive posterior spinal fusions were performed for multilevel disease and/or deformity correction utilizing robotic-assisted placement of pedicle screws. The primary outcome was surgery-related failure, which was defined as hardware breakage or reoperation with removal of hardware. A total of 100 consecutive patients met inclusion criteria. Among cases included, 31 were revision surgeries with existing hardware in place. The mean number of levels fused was 5.6, the mean operative time was 303 min, and the mean estimated blood loss was 469 mL. 28 cases included robotic-assisted placement of S2 alar-iliac (S2AI) screws. In total, 1043 pedicle screws and 53 S2AI screws were placed with robotic-assistance. The failure rate using survivorship analysis was 18/1043 (1.7%) and the failure rate of S2AI screws using survivorship analysis was 3/53 (5.7%). Four patients developed postoperative wound infections requiring irrigation and debridement procedures. None of the 1043 pedicle screws nor the 53 S2AI screws required reoperation due to malpositioning or suboptimal placement. This case series of 100 multilevel posterior spinal fusion procedures demonstrates promising results with low failure rates. With 1043 pedicle screws and 53 S2AI screws, we report low failure rates of 1.7% and 5.7%, respectively with zero cases of screw malpositioning. Robotic screw placement allows for accurate screw placement with no increased rate of postoperative infection compared to historical controls. Level of evidence: IV, Retrospective review.
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Bhatt FR, Orosz LD, Tewari A, Boyd D, Roy R, Good CR, Schuler TC, Haines CM, Jazini E. Augmented Reality-Assisted Spine Surgery: An Early Experience Demonstrating Safety and Accuracy with 218 Screws. Global Spine J 2023; 13:2047-2052. [PMID: 35000409 PMCID: PMC10556900 DOI: 10.1177/21925682211069321] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES In spine surgery, accurate screw guidance is critical to achieving satisfactory fixation. Augmented reality (AR) is a novel technology to assist in screw placement and has shown promising results in early studies. This study aims to provide our early experience evaluating safety and efficacy with an Food and Drug Administration-approved head-mounted (head-mounted device augmented reality (HMD-AR)) device. METHODS Consecutive adult patients undergoing AR-assisted thoracolumbar fusion between October 2020 and August 2021 with 2 -week follow-up were included. Preoperative, intraoperative, and postoperative data were collected to include demographics, complications, revision surgeries, and AR performance. Intraoperative 3D imaging was used to assess screw accuracy using the Gertzbein-Robbins (G-R) grading scale. RESULTS Thirty-two patients (40.6% male) were included with a total of 222 screws executed using HMD-AR. Intraoperatively, 4 (1.8%) were deemed misplaced and revised using AR or freehand. The remaining 218 (98.2%) screws were placed accurately. There were no intraoperative adverse events or complications, and AR was not abandoned in any case. Of the 208 AR-placed screws with 3D imaging confirmation, 97.1% were considered clinically accurate (91.8% Grade A, 5.3% Grade B). There were no early postoperative surgical complications or revision surgeries during the 2 -week follow-up. CONCLUSIONS This early experience study reports an overall G-R accuracy of 97.1% across 218 AR-guided screws with no intra or early postoperative complications. This shows that HMD-AR-assisted spine surgery is a safe and accurate tool for pedicle, cortical, and pelvic fixation. Larger studies are needed to continue to support this compelling evolution in spine surgery.
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Affiliation(s)
| | | | - Anant Tewari
- National Spine Health Foundation, Reston, VA, USA
| | - David Boyd
- Reston Radiology Consultants, Reston, VA, USA
| | - Rita Roy
- National Spine Health Foundation, Reston, VA, USA
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Shahi P, Maayan O, Shinn D, Dalal S, Song J, Araghi K, Melissaridou D, Vaishnav A, Shafi K, Pompeu Y, Sheha E, Dowdell J, Iyer S, Qureshi SA. Floor-Mounted Robotic Pedicle Screw Placement in Lumbar Spine Surgery: An Analysis of 1,050 Screws. Neurospine 2023; 20:577-586. [PMID: 37401076 PMCID: PMC10323346 DOI: 10.14245/ns.2346070.035] [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: 01/14/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE To analyze the usage of floor-mounted robot in minimally invasive lumbar fusion. METHODS Patients who underwent minimally invasive lumbar fusion for degenerative pathology using floor-mounted robot (ExcelsiusGPS) were included. Pedicle screw accuracy, proximal level violation rate, pedicle screw size, screw-related complications, and robot abandonment rate were analyzed. RESULTS Two hundred twenty-nine patients were included. Most surgeries were primary single-level fusion. Sixty-five percent of surgeries had intraoperative computed tomography (CT) workflow, 35% had preoperative CT workflow. Sixty-six percent were transforaminal lumbar interbody fusion, 16% were lateral, 8% were anterior, and 10% were a combined approach. A total of 1,050 screws were placed with robotic assistance (85% in prone position, 15% in lateral position). Postoperative CT scan was available for 80 patients (419 screws). Overall pedicle screw accuracy rate was 96.4% (prone, 96.7%; lateral, 94.2%; primary, 96.7%; revision, 95.3%). Overall poor screw placement rate was 2.8% (prone, 2.7%; lateral, 3.8%; primary, 2.7%; revision, 3.5%). Overall proximal facet and endplate violation rates were 0.4% and 0.9%. Average diameter and length of pedicle screws were 7.1 mm and 47.7 mm. Screw revision had to be done for 1 screw (0.1%). Use of the robot had to be aborted in 2 cases (0.8%). CONCLUSION Usage of floor-mounted robotics for the placement of lumbar pedicle screws leads to excellent accuracy, large screw size, and negligible screw-related complications. It does so for screw placement in prone/lateral position and primary/revision surgery alike with negligible robot abandonment rates.
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Affiliation(s)
| | - Omri Maayan
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Junho Song
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | - Karim Shafi
- Hospital for Special Surgery, New York, NY, USA
| | - Yuri Pompeu
- Hospital for Special Surgery, New York, NY, USA
| | - Evan Sheha
- Hospital for Special Surgery, New York, NY, USA
| | | | - Sravisht Iyer
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Sheeraz A. Qureshi
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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10
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Kanaly CW, Backes DM, Toossi N, Bucklen B. A Retrospective Analysis of Pedicle Screw Placement Accuracy Using the ExcelsiusGPS Robotic Guidance System: Case Series. Oper Neurosurg (Hagerstown) 2023; 24:242-247. [PMID: 36454079 DOI: 10.1227/ons.0000000000000498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Robotic guidance has become widespread in spine surgery. Although the intent is improved screw placement, further system-specific data are required to substantiate this intention for pedicle screws in spinal stabilization constructs. OBJECTIVE To determine the accuracy of pedicle screws placed with the aid of a robot in a cohort of patients immediately after the adoption of the robot-assisted surgery technique. METHODS A retrospective, Institutional Review Board-approved study was performed on the first 100 patients at a single facility, who had undergone spinal surgeries with the use of robotic techniques. Pedicle screw accuracy was graded using the Gertzbein-Robbins Scale based on pedicle wall breach, with grade A representing 0 mm breach and successive grades increasing breach thresholds by 2 mm increments. Preoperative and postoperative computed tomography scans were also used to assess offsets between the objective plan and true screw placements. RESULTS A total of 326 screws were analyzed among 72 patients with sufficient imaging data. Ages ranged from 21 to 84 years. The total accuracy rate based on the Gertzbein-Robbins Scale was 97.5%, and the rate for each grade is as follows: A, 82%; B, 15.5%; C, 1.5%; D, 1%; and E, 0. The average tip offset was 1.9 mm, the average tail offset was 2.0 mm, and the average angular offset was 2.6°. CONCLUSION Robotic-assisted surgery allowed for accurate implantation of pedicle screws on immediate adoption of this technique. There were no complications attributable to the robotic technique, and no hardware revisions were required.
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Affiliation(s)
- Charles W Kanaly
- Steward St. Anne's Hospital, Fall River, Massachusetts, USA
- Neurosurgery Center of Southern New England, PC, Fall River, Massachusetts, USA
| | - Danielle M Backes
- Neurosurgery Center of Southern New England, PC, Fall River, Massachusetts, USA
| | - Nader Toossi
- Musculoskeletal and Education Research Center, Clinical Research Department, Audubon, Pennsylvania, USA
| | - Brandon Bucklen
- Musculoskeletal and Education Research Center, Clinical Research Department, Audubon, Pennsylvania, USA
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11
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Cirrincione P, Widmann RF, Heyer JH. Advances in robotics and pediatric spine surgery. Curr Opin Pediatr 2023; 35:102-109. [PMID: 36354112 DOI: 10.1097/mop.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE OF REVIEW Robotic-assisted surgical navigation for placement of pedicle screws is one of the most recent technological advancements in spine surgery. Excellent accuracy and reliability results have been documented in the adult population, but adoption of robotic surgical navigation is uncommon in pediatric spinal deformity surgery. Pediatric spinal anatomy and the specific pediatric pathologies present unique challenges to adoption of robotic assisted spinal deformity workflows. The purpose of this article is to review the safety, accuracy and learning curve data for pediatric robotic-assisted surgical navigation as well as to identify "best use" cases and technical tips. RECENT FINDINGS Robotic navigation has been demonstrated as a safe, accurate and reliable method to place pedicle screws in pediatric patients with a moderate learning curve. There are no prospective studies comparing robotically assisted pedicle screw placement with other techniques for screw placement, however several recent studies in the pediatric literature have demonstrated high accuracy and safety as well as high reliability. In addition to placement of pediatric pedicle screws in the thoracic and lumbar spine, successful and safe placement of screws in the pelvis and sacrum have also been reported with reported advantages over other techniques in the setting of high-grade spondylolisthesis as well as pelvic fixation utilizing S2-alar iliac (S2AI) screws. SUMMARY Early studies have demonstrated that robotically assisted surgical navigation for pedicle screws and pelvic fixation for S2AI screws is safe, accurate, and reliable in the pediatric population with a moderate learning curve.
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Affiliation(s)
- Peter Cirrincione
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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12
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Zimmermann F, Franke J, Vetter SY, Grützner PA. [Computer-assisted procedures in orthopedics and trauma surgery-Where do we stand?]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:292-298. [PMID: 36600030 DOI: 10.1007/s00104-022-01789-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/06/2023]
Abstract
Computer-assisted procedures are becoming increasingly more relevant in orthopedics and trauma surgery. The data situation on these systems has improved in recent years but still has a low level of evidence. In particular, data on short-term or medium-term results on the use of these procedures are currently available. These could show that improved precision and reproducibility of the surgical procedures can be achieved by the use of computer-assisted procedures. Nevertheless, there is still no recommendation in the current guidelines for routine use.
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Affiliation(s)
- Felix Zimmermann
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland.
| | - Jochen Franke
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Sven Y Vetter
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Paul A Grützner
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
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Mualem W, Onyedimma C, Ghaith AK, Durrani S, Jarrah R, Singh R, Zamanian C, Nathani KR, Freedman BA, Bydon M. R2 advances in robotic-assisted spine surgery: comparative analysis of options, future directions, and bibliometric analysis of the literature. Neurosurg Rev 2022; 46:18. [PMID: 36515789 DOI: 10.1007/s10143-022-01916-y] [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] [Indexed: 12/15/2022]
Abstract
Spine surgery has undergone rapid advancements over the past several decades with the emergence of robotic and minimally invasive surgery (MIS). While conventional MIS spine surgery has had relative success, its complication profile has warranted continued efforts to improve clinical outcomes. We discuss the functional, clinical, and financial aspects of four robotic options for spinal pathologies, namely ROSA, Mazor X, Da Vinci, and ExcelsiusGPS, and conduct a bibliometric analysis to better understand current trends and applications of these robots as the field of robotic spine surgery continues to grow. An extensive search of English-language published literature on robotic-assisted spinal surgery was performed in Elsevier's Scopus database. A bibliometric analysis was then performed on the top 100 most cited papers. The search yielded articles regarding robotic-assisted spine surgery application, limitations, and functional outcomes secondary to spine pathology. Accuracy analyses of 1733 screw placements were reviewed. The top 100 papers were published between 1992 and 2020, with a significant increase from 2015 onwards. The top publishing institution was John Hopkins University (n = 8). The top contributing author was Dr. Isador H. Lieberman (n = 6). The USA (n = 34) had the most articles on robotic spinal surgery, followed by Germany (n = 12). This review examines robotic applications in spine surgery, including four available options: ROSA, Mazor X, Da Vinci, and ExcelsiusGPS. Publication output over time, surgical outcomes, screw accuracy, and cost-effectiveness of these technologies have been investigated here. Certain robots have functional, clinical, and financial differences worth noting. Given the dearth of existing literature reporting postoperative complications and long-term comparative outcomes, there is a clear need for further studies on this matter.
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Affiliation(s)
- William Mualem
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Chiduziem Onyedimma
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Sulaman Durrani
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Ryan Jarrah
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Rohin Singh
- Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
- Department of Neurologic Surgery, Mayo Clinic, Scottsdale, AZ, USA
| | - Cameron Zamanian
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Karim Rizwan Nathani
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA.
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Muacevic A, Adler JR, Cornwell B, Nagarajan M, Smith ZA. Robot-Assisted Thoracolumbar Fixation After Acute Spinal Trauma: A Case Series. Cureus 2022; 14:e31832. [PMID: 36579235 PMCID: PMC9788792 DOI: 10.7759/cureus.31832] [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: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pedicle screw fixation has become the workhorse for the stabilization of the thoracolumbar spine. Since accurate pedicle screw placement is necessary for a successful surgery, three-dimensional navigation has become a mainstay for placing pedicle screws. However, the published studies have an overrepresentation of lumbar screws despite the prevalence of thoracic fractures. Furthermore, no robotic-assisted pedicle screw study has focused solely on traumatic fractures. The goal of this study was to address whether (1) robot-assisted pedicle screw placement had comparable accuracy in the thoracic and thoracolumbar region and (2) robot-assisted spine surgery was feasible in an acute, traumatic setting. METHODS We performed 14 consecutive, thoracolumbar spinal stabilization procedures in which 126 pedicle screws were placed using the Globus ExcelsiusGPS® spine robot in an acute, traumatic setting. Operative times were measured, and the accuracy of pedicle screws was assessed with the Gertzbein and Robbins classification system by two board-certified neuroradiologists. RESULTS A total of 60-thoracic (T3-T11), the 24-thoracolumbar junction (T12-L1), 40-lumbar (L2-L5), and two-sacral pedicle screws were placed. Pedicle screw placement was accurate with a < 1% (1/126) pedicle breach rate. Thoracolumbar robotic spine surgery in an acute, traumatic setting was demonstrated to have a good safety profile with only one minor neurological deficit which was related to positioning. Furthermore, surgical times were inversely related to the case number. CONCLUSIONS These results together suggest that robot-assisted spine surgery is accurate in the thoracic spine. Furthermore, placement of thoracolumbar screws in an acute trauma is non-inferior to other methods when based on accuracy.
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Abstract
STUDY DESIGN Systematic review. OBJECTIVE The aim of this review is to present an overview of robotic spine surgery (RSS) including its history, applications, limitations, and future directions. SUMMARY OF BACKGROUND DATA The first RSS platform received United States Food and Drug Administration approval in 2004. Since then, robotic-assisted placement of thoracolumbar pedicle screws has been extensively studied. More recently, expanded applications of RSS have been introduced and evaluated. METHODS A systematic search of the Cochrane, OVID-MEDLINE, and PubMed databases was performed for articles relevant to robotic spine surgery. Institutional review board approval was not needed. RESULTS The placement of thoracolumbar pedicle screws using RSS is safe and accurate and results in reduced radiation exposure for the surgeon and surgical team. Barriers to utilization exist including learning curve and large capital costs. Additional applications involving minimally invasive techniques, cervical pedicle screws, and deformity correction have emerged. CONCLUSION Interest in RSS continues to grow as the applications advance in parallel with image guidance systems and minimally invasive techniques. IRB APPROVAL N/A.
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Sacino AN, Materi J, Davidar AD, Judy B, Liu A, Hwang B, Theodore N. Robot-assisted atlantoaxial fixation: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE22114. [PMID: 35733845 PMCID: PMC9210265 DOI: 10.3171/case22114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Placing screws in the high cervical spine can be challenging because of the vital anatomical structures located in that region. Precision and accuracy with screw placement is needed. The use of robotics in the cervical spine has been described before; however, here the authors describe the use of a new robotic setup. OBSERVATIONS The authors describe 2 cases of robot-assisted placement of C2 pars screws and C1–2 transarticular screws. The operative plans for each patient were as follows: placement of C2 pars screws with C2–4 fusion for hangman’s fracture and placement of C1–2 transarticular screws for degenerative disease. Intraoperative computed tomography (CT) was used to plan and navigate the screws. Postoperative CT showed excellent placement of hardware. Both patients presented for initial postoperative clinic visits with no recurrence of prior symptoms. LESSONS Intraoperative robotic assistance with instrumentation of the high cervical spine, particularly C2 pars and C1–2 transarticular screws, may ensure proper screw placement and help avoid injury.
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Affiliation(s)
- Amanda N. Sacino
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joshua Materi
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - A. Daniel Davidar
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brendan Judy
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brian Hwang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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17
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Satin AM, Kisinde S, Lieberman IH. Can Robotic Spine Surgery Become the Standard of Care? Int J Spine Surg 2022; 16:S44-S49. [PMID: 35764357 PMCID: PMC9808788 DOI: 10.14444/8276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Concerns regarding traditional techniques led to the development of robotic systems to facilitate the safe and accurate placement of pedicle screws. The Mazor Spine Assist was the first robotic spine surgery (RSS) platform to receive US Food and Drug Administration approval in 2004. Since then, there has been a steady increase in the application of RSS with several additional iterations of the Mazor platform and other competing systems receiving approval. As the indications, potential benefits, and utilization of RSS continue to expand, the question naturally arises as to whether RSS will eventually become the standard of care for spine surgery. In this article, we review the available evidence and experience with RSS and discuss the potential for RSS to become the medical standard of care.
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Affiliation(s)
| | | | - Isador H. Lieberman
- Texas Back Institute, Plano, Texas, USA, Isador H. Lieberman, Scoliosis and Spine Tumor Center, 6020 W Parker Rd, 200, Plano, TX 75093, USA;
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Liounakos JI, Khan A, Eliahu K, Mao JZ, Good CR, Pollina J, Haines CM, Gum JL, Schuler TC, Jazini E, Chua RV, Shafa E, Buchholz AL, Pham MH, Poelstra KA, Wang MY. Ninety-day complication, revision, and readmission rates for current-generation robot-assisted thoracolumbar spinal fusion surgery: results of a multicenter case series. J Neurosurg Spine 2022; 36:841-848. [PMID: 34826805 DOI: 10.3171/2021.8.spine21330] [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: 03/27/2021] [Accepted: 08/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Robotics is a major area for research and development in spine surgery. The high accuracy of robot-assisted placement of thoracolumbar pedicle screws is documented in the literature. The authors present the largest case series to date evaluating 90-day complication, revision, and readmission rates for robot-assisted spine surgery using the current generation of robotic guidance systems. METHODS An analysis of a retrospective, multicenter database of open and minimally invasive thoracolumbar instrumented fusion surgeries using the Mazor X or Mazor X Stealth Edition robotic guidance systems was performed. Patients 18 years of age or older and undergoing primary or revision surgery for degenerative spinal conditions were included. Descriptive statistics were used to calculate rates of malpositioned screws requiring revision, as well as overall complication, revision, and readmission rates within 90 days. RESULTS In total, 799 surgical cases (Mazor X: 48.81%; Mazor X Stealth Edition: 51.19%) were evaluated, involving robot-assisted placement of 4838 pedicle screws. The overall intraoperative complication rate was 3.13%. No intraoperative implant-related complications were encountered. Postoperatively, 129 patients suffered a total of 146 complications by 90 days, representing an incidence of 16.1%. The rate of an unrecognized malpositioned screw resulting in a new postoperative radiculopathy requiring revision surgery was 0.63% (5 cases). Medical and pain-related complications unrelated to hardware placement accounted for the bulk of postoperative complications within 90 days. The overall surgical revision rate at 90 days was 6.63% with 7 implant-related revisions, representing an implant-related revision rate of 0.88%. The 90-day readmission rate was 7.13% with 2 implant-related readmissions, representing an implant-related readmission rate of 0.25% of cases. CONCLUSIONS The results of this multicenter case series and literature review suggest current-generation robotic guidance systems are associated with low rates of intraoperative and postoperative implant-related complications, revisions, and readmissions at 90 days. Future outcomes-based studies are necessary to evaluate complication, revision, and readmission rates compared to conventional surgery.
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Affiliation(s)
| | - Asham Khan
- 2Department of Neurosurgery, University at Buffalo, New York
| | - Karen Eliahu
- 1Department of Neurological Surgery, University of Miami, Florida
| | - Jennifer Z Mao
- 2Department of Neurosurgery, University at Buffalo, New York
| | | | - John Pollina
- 2Department of Neurosurgery, University at Buffalo, New York
| | | | - Jeffrey L Gum
- 4Norton Leatherman Spine Center, Louisville, Kentucky
| | | | | | | | - Eiman Shafa
- 6Twin Cities Spine Center, Minneapolis, Minnesota
| | - Avery L Buchholz
- 7Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Martin H Pham
- 8Department of Neurosurgery, UC San Diego School of Medicine, La Jolla, California; and
| | | | - Michael Y Wang
- 1Department of Neurological Surgery, University of Miami, Florida
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19
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Robot-assisted (RA) versus conventional total knee replacement. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Driver J, Groff MW. Editorial. Navigation in spine surgery: an innovation here to stay. J Neurosurg Spine 2022; 36:347-349. [PMID: 34624836 DOI: 10.3171/2021.4.spine21207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Joseph Driver
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael W Groff
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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21
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Li Z, Jiang S, Song X, Liu S, Wang C, Hu L, Li W. Collaborative spinal robot system for laminectomy: a preliminary study. Neurosurg Focus 2022; 52:E11. [DOI: 10.3171/2021.10.focus21499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The application of robots in the field of pedicle screw placement has achieved great success. However, decompressive laminectomy, a step that is just as critical as pedicle screw placement, does not have a mature robot-assisted system. To address this lack, the authors designed a collaborative spine robot system to assist with laminectomy. In this study, they aimed to investigate the reliability of this novel collaborative spinal robot system and compare it with manual laminectomy (ML).
METHODS
Thirty in vitro porcine lumbar vertebral specimens were obtained as experimental bone specimens. Robot-assisted laminectomy (RAL) was performed on the left side of the lamina (n = 30) and ML was performed on the right side (n = 30). The time required for laminectomy on one side, whether the lamina was penetrated, and the remaining thickness of the lamina were compared between the two groups.
RESULTS
The time required for laminectomy on one side was longer in the RAL group than in the ML group (median 326 seconds [IQR 133 seconds] vs 108.5 seconds [IQR 43 seconds], p < 0.001). In the RAL group, complete lamina penetration occurred twice (6.7%), while in the ML group, it occurred 9 times (30%); the difference was statistically significant (p = 0.045). There was no statistically significant difference in the remaining lamina thickness between the two groups (median 1.035 mm [IQR 0.419 mm] vs 1.084 mm [IQR 0.383 mm], p = 0.842).
CONCLUSIONS
The results of this study confirm the safety of this novel spinal robot system for laminectomy. However, its efficiency requires further improvement.
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Affiliation(s)
- Zhuofu Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing
- Beijing Key Laboratory of Spinal Disease Research, Beijing
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing; and
| | - Shuai Jiang
- Department of Orthopaedics, Peking University Third Hospital, Beijing
- Beijing Key Laboratory of Spinal Disease Research, Beijing
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing; and
| | | | - Shanshan Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing
- Beijing Key Laboratory of Spinal Disease Research, Beijing
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing; and
| | - Chengxia Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing
- Beijing Key Laboratory of Spinal Disease Research, Beijing
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing; and
| | - Lei Hu
- Robotics Institute, Beihang University, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing
- Beijing Key Laboratory of Spinal Disease Research, Beijing
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing; and
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22
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Pojskić M, Bopp M, Nimsky C, Carl B, Saβ B. Initial Intraoperative Experience with Robotic-Assisted Pedicle Screw Placement with Cirq ® Robotic Alignment: An Evaluation of the First 70 Screws. J Clin Med 2021; 10:jcm10245725. [PMID: 34945020 PMCID: PMC8703981 DOI: 10.3390/jcm10245725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Robot-guided spine surgery is based on a preoperatively planned trajectory that is reproduced in the operating room by the robotic device. This study presents our initial experience with thoracolumbar pedicle screw placement using Brainlab's Cirq® surgeon-controlled robotic arm (BrainLab, Munich, Germany). METHODS All patients who underwent robotic-assisted implantation of pedicle screws in the thoracolumbar spine were included in the study. Our workflow, consisting of preoperative imagining, screw planning, intraoperative imaging with automatic registration, fusion of the preoperative and intraoperative imaging with a review of the preplanned screw trajectories, robotic-assisted insertion of K-wires, followed by a fluoroscopy-assisted insertion of pedicle screws and control iCT scan, is described. RESULTS A total of 12 patients (5 male and 7 females, mean age 67.4 years) underwent 13 surgeries using the Cirq® Robotic Alignment Module for thoracolumbar pedicle screw implantation. Spondylodiscitis, metastases, osteoporotic fracture, and spinal canal stenosis were detected. A total of 70 screws were implanted. The mean time per screw was 08:27 ± 06:54 min. The mean time per screw for the first 7 surgeries (first 36 screws) was 16:03 ± 09:32 min and for the latter 6 surgeries (34 screws) the mean time per screw was 04:35 ± 02:11 min (p < 0.05). Mean entry point deviation was 1.9 ± 1.23 mm, mean deviation from the tip of the screw was 2.61 ± 1.6 mm and mean angular deviation was 3.5° ± 2°. For screw-placement accuracy we used the CT-based Gertzbein and Robbins System (GRS). Of the total screws, 65 screws were GRS A screws (92.85%), one screw was a GRS B screw, and two further screws were grade C. Two screws were D screws (2.85%) and underwent intraoperative revision. There were no perioperative deficits. CONCLUSION Brainlab's Cirq® Robotic Alignment surgeon-controlled robotic arm is a safe and beneficial method for accurate thoracolumbar pedicle screw placement with high accuracy.
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Affiliation(s)
- Mirza Pojskić
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Correspondence: ; Tel.: +49-642-1586-9848
| | - Miriam Bopp
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany
| | - Barbara Carl
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 65199 Marburg, Germany
- Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, 65199 Wiesbaden, Germany
| | - Benjamin Saβ
- Department of Neurosurgery, University of Marburg, 65199 Marburg, Germany; (M.B.); (C.N.); (B.C.); (B.S.)
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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: 23] [Impact Index Per Article: 7.7] [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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Chesney K, Triano M, Dowlati E, Zhang I, Felbaum DR, Aulisi EF. Cirq robotic arm-assisted transpedicular instrumentation with intraoperative navigation: technical note and case series with 714 thoracolumbar screws. J Robot Surg 2021; 16:893-898. [PMID: 34606045 DOI: 10.1007/s11701-021-01313-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022]
Abstract
The Cirq is a surgeon-controlled robotic arm that provides a new technique for accurately placing transpedicular screws. This report aims to present a technical report and our experience with this new robotic arm combined with intraoperative navigation. Technique and workflow using the Cirq robotic arm with intraoperative navigation is described. A retrospective review was conducted of all patients undergoing elective open thoracic/lumbar fusion surgery by a single surgeon in the first year of using the novel Cirq robotic arm. Descriptive analysis of patient and operative variables was performed. A total of 84 patients underwent placement of a total 714 transpedicular screws using the Cirq robotic arm. Most (69.1%) underwent 3-6 level fusion procedures. Mean operative time was 198 min total and 28 min when adjusted per screw. There was a learning curve with operative time per screw decreasing from 32 to 25 min from the first to second half of cases (p = 0.057). There were no intraoperative screw revisions and 2.4% (2/84) required instrumentation revision and return to the operating room. The Cirq robotic arm is seamlessly incorporated into the workflow of a transpedicular fusion. Our experience with over 700 pedicle screw placements using the Cirq robot demonstrates efficacy and safety although further comparative studies are needed.
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Affiliation(s)
- Kelsi Chesney
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Matthew Triano
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Irma Zhang
- Georgetown University School of Medicine, Washington, DC, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC, 20010, USA
| | - Edward F Aulisi
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
- Department of Neurosurgery, MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC, 20010, USA.
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Abstract
As robotics in spine surgery has progressed over the past 2 decades, studies have shown mixed results on its clinical outcomes and economic impact. In this review, we highlight the evolution of robotic technology over the past 30 years, discussing early limitations and failures. We provide an overview of the history and evolution of currently available spinal robotic platforms and compare and contrast the available features of each. We conclude by summarizing the literature on robotic instrumentation accuracy in pedicle screw placement and clinical outcomes such as complication rates and briefly discuss the future of robotic spine surgery.
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Affiliation(s)
| | | | | | | | - Darren R. Lebl
- Weill Cornell Medicine, New York, NY, USA
- Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A. Qureshi
- Weill Cornell Medicine, New York, NY, USA
- Hospital for Special Surgery, New York, NY, USA
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26
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Yahanda AT, Moore E, Ray WZ, Pennicooke B, Jennings JW, Molina CA. First in-human report of the clinical accuracy of thoracolumbar percutaneous pedicle screw placement using augmented reality guidance. Neurosurg Focus 2021; 51:E10. [PMID: 34333484 DOI: 10.3171/2021.5.focus21217] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Augmented reality (AR) is an emerging technology that has great potential for guiding the safe and accurate placement of spinal hardware, including percutaneous pedicle screws. The goal of this study was to assess the accuracy of 63 percutaneous pedicle screws placed at a single institution using an AR head-mounted display (ARHMD) system. METHODS Retrospective analyses were performed for 9 patients who underwent thoracic and/or lumbar percutaneous pedicle screw placement guided by ARHMD technology. Clinical accuracy was assessed via the Gertzbein-Robbins scale by the authors and by an independent musculoskeletal radiologist. Thoracic pedicle subanalysis was also performed to assess screw accuracy based on pedicle morphology. RESULTS Nine patients received thoracic or lumbar AR-guided percutaneous pedicle screws. The mean age at the time of surgery was 71.9 ± 11.5 years and the mean number of screws per patient was 7. Indications for surgery were spinal tumors (n = 4, 44.4%), degenerative disease (n = 3, 33.3%), spinal deformity (n = 1, 11.1%), and a combination of deformity and infection (n = 1, 11.1%). Presenting symptoms were most commonly low-back pain (n = 7, 77.8%) and lower-extremity weakness (n = 5, 55.6%), followed by radicular lower-extremity pain, loss of lower-extremity sensation, or incontinence/urinary retention (n = 3 each, 33.3%). In all, 63 screws were placed (32 thoracic, 31 lumbar). The accuracy for these screws was 100% overall; all screws were Gertzbein-Robbins grade A or B (96.8% grade A, 3.2% grade B). This accuracy was achieved in the thoracic spine regardless of pedicle cancellous bone morphology. CONCLUSIONS AR-guided surgery demonstrated a 100% accuracy rate for the insertion of 63 percutaneous pedicle screws in 9 patients (100% rate of Gertzbein-Robbins grade A or B screw placement). Using an ARHMS system for the placement of percutaneous pedicle screws showed promise, but further validation using a larger cohort of patients across multiple surgeons and institutions will help to determine the true accuracy enabled by this technology.
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Affiliation(s)
| | - Emelia Moore
- 2Wayne State University School of Medicine, Detroit, Michigan
| | | | | | - Jack W Jennings
- 3Radiology, Washington University School of Medicine in St. Louis, Missouri; and
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27
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McKenzie DM, Westrup AM, O'Neal CM, Lee BJ, Shi HH, Dunn IF, Snyder LA, Smith ZA. Robotics in spine surgery: A systematic review. J Clin Neurosci 2021; 89:1-7. [PMID: 34119250 DOI: 10.1016/j.jocn.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/13/2021] [Accepted: 04/04/2021] [Indexed: 12/20/2022]
Abstract
Robotic systems to assist with pedicle screw placement have recently emerged in the field of spine surgery. Here, the authors systematically reviewed the literature for evidence of these robotic systems and their utility. Thirty-four studies that reported the use of spinal instrumentation with robotic assistance and met inclusion criteria were identified. The outcome measures gathered included: pedicle screw accuracy, indications for surgery, rates of conversion to an alternative surgical method, radiation exposure, and learning curve. In our search there were five different robotic systems identified. All studies reported accuracy and the most commonly used accuracy grading scale was the Gertzbein Robbins scale (GRS). Accuracy of clinically acceptable pedicle screws, defined as < 2 mm cortical breech, ranged from 80% to 100%. Many studies categorized indications for robotic surgery with the most common being degenerative entities. Some studies reported rates of conversion from robotic assistance to manual instrumentation due to many reasons, with robotic failure as the most common. Radiation exposure data revealed a majority of studies reported less radiation using robotic systems. Studies looking at a learning curve effect with surgeon use of robotic assistance were not consistent across the literature. Robotic systems for assistance in spine surgery have continued to improve and the accuracy of pedicle screw placement remains superior when compared to free-hand technique, however rates of manual conversion are significant. Currently, these systems are successfully employed in various pathological entities where trained spine surgeons can be safe and accurate regardless of robotic training.
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Affiliation(s)
- Daniel M McKenzie
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alison M Westrup
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christen M O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Benjamin J Lee
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Helen H Shi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Laura A Snyder
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Zachary A Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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28
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Safety and accuracy of robot-assisted placement of pedicle screws compared to conventional free-hand technique: a systematic review and meta-analysis. Spine J 2021; 21:181-192. [PMID: 32976997 DOI: 10.1016/j.spinee.2020.09.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The introduction and integration of robot technology into modern spine surgery provides surgeons with millimeter accuracy for pedicle screw placement. Coupled with computer-based navigation platforms, robot-assisted spine surgery utilizes augmented reality to potentially improve the safety profile of instrumentation. PURPOSE In this study, the authors seek to determine the safety and efficacy of robotic-assisted pedicle screw placement compared to conventional free-hand (FH) technique. STUDY DESIGN/SETTING We conducted a systematic review of the electronic databases using different MeSH terms from 1980 to 2020. OUTCOME MEASURES The present study measures pedicle screw accuracy, complication rates, proximal-facet joint violation, intraoperative radiation time, radiation dosage, and length of surgery. RESULTS A total of 1,525 patients (7,379 pedicle screws) from 19 studies with 777 patients (51.0% with 3,684 pedicle screws) in the robotic-assisted group were included. Perfect pedicle screw accuracy, as categorized by Gerztbein-Robbin Grade A, was significantly superior with robotic-assisted surgery compared to FH-technique (Odds ratio [OR]: 1.68, 95% confidence interval [CI]: 1.20-2.35; p=.003). Similarly, clinically acceptable pedicle screw accuracy (Grade A+B) was significantly higher with robotic-assisted surgery versus FH-technique (OR: 1.54, 95% CI: 1.01-2.37; p=.05). Furthermore, the complication rates and proximal-facet joint violation were 69% (OR: 0.31, 95% CI: 0.20-0.48; p<.00001) and 92% less likely (OR: 0.08, 95% CI: 0.03-0.20; p<.00001) with robotic-assisted surgery versus FH-group. Robotic-assisted pedicle screw implantation significantly reduced intraoperative radiation time (MD: -5.30, 95% CI: -6.83-3.76; p<.00001) and radiation dosage (MD: -3.70, 95% CI: -4.80-2.60; p<.00001) compared to the conventional FH-group. However, the length of surgery was significantly higher with robotic-assisted surgery (MD: 22.70, 95% CI: 6.57-38.83; p=.006) compared to the FH-group. CONCLUSION This meta-analysis corroborates the accuracy of robot-assisted pedicle screw placement.
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29
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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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30
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Chapman JR, Wang JC, Wiechert K. Are "Replicants" the Spine Surgeons of the Future? Global Spine J 2020; 10:249-251. [PMID: 32313788 PMCID: PMC7160800 DOI: 10.1177/2192568220905883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jens R. Chapman
- Swedish Neuroscience Institute, Swedish Medical Center,
Seattle, WA, USA
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31
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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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32
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Jiang B, Azad TD, Cottrill E, Zygourakis CC, Zhu AM, Crawford N, Theodore N. New spinal robotic technologies. Front Med 2019; 13:723-729. [PMID: 31673935 DOI: 10.1007/s11684-019-0716-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/05/2019] [Indexed: 01/07/2023]
Abstract
Robotic systems in surgery have developed rapidly. Installations of the da Vinci Surgical System® (Intuitive Surgical, Sunnyvale, CA, USA), widely used in urological and gynecological procedures, have nearly doubled in the United States from 2010 to 2017. Robotics systems in spine surgery have been adopted more slowly; however, users are enthusiastic about their applications in this subspecialty. Spinal surgery often requires fine manipulation of vital structures that must be accessed via limited surgical corridors and can require repetitive tasks over lengthy periods of time - issues for which robotic assistance is well-positioned to complement human ability. To date, the United States Food and Drug Administration (FDA) has approved 7 robotic systems across 4 companies for use in spinal surgery. The available clinical data evaluating their efficacy have generally demonstrated these systems to be accurate and safe. A critical next step in the broader adoption of surgical robotics in spine surgery is the design and implementation of rigorous comparative studies to interrogate the utility of robotic assistance. Here we discuss current applications of robotics in spine surgery, review robotic systems FDA-approved for use in spine surgery, summarize randomized controlled trials involving robotics in spine surgery, and comment on prospects of robotic-assisted spine surgery.
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Affiliation(s)
- Bowen Jiang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Tej D Azad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Corinna C Zygourakis
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Alex M Zhu
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | | | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
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33
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Huntsman KT, Riggleman JR, Ahrendtsen LA, Ledonio CG. Navigated robot-guided pedicle screws placed successfully in single-position lateral lumbar interbody fusion. J Robot Surg 2019; 14:643-647. [PMID: 31625074 PMCID: PMC7347701 DOI: 10.1007/s11701-019-01034-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/03/2019] [Indexed: 11/24/2022]
Abstract
Minimally invasive lateral interbody fusion has distinct advantages over traditional posterior approaches. When posterior stabilization is needed, percutaneous placement of pedicle screws from the lateral decubitus position may potentially increase safety and improve operative efficiency by precluding the need for repositioning. However, safe placement of pedicle screws in the lateral position remains technically challenging. This study describes the pedicle screw placement of single-position lateral lumbar interbody fusion (SP-LLIF) cases in which navigated robotic assistance was used. A single-surgeon, single-site, retrospective Institutional Review Board-exempt review of the first 55 SP-LLIF navigated robot-assisted spine surgery cases performed by the lead author was conducted. An orthopaedic surgeon evaluated screw placement using plain film radiographs. In addition, pedicle screw malposition, reposition, and return to operating room (OR) rates were collected. In the first 55 SP-LLIF cases, 342 pedicle screws were placed. The average patient age and body mass index were 67 years and 29.5 kg/m2, respectively. Of the 342 screws placed, 4% (14/342) were placed manually without the robot, due to surgeon discretion. Of the 328 screws placed with the robot, 2% (7/328) were repositioned based on the surgeon’s discretion, resulting in a 98% navigated robot-assisted pedicle screw placement success rate. In this cohort there were no revisions due to malpositioned screws. No complications due to screw placement were reported. This study demonstrates a high level (98%) of successful surgeon-assessed pedicle screw placement in minimally invasive navigated robot-assisted SP-LLIF, with no malpositions requiring a return to the OR.
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Affiliation(s)
- Kade T Huntsman
- Salt Lake Orthopaedic Clinic, Suite 500, 1160 East 3900 South, Salt Lake City, UT, 84124, USA
| | - Jessica R Riggleman
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA, 19403, USA.
| | - Leigh A Ahrendtsen
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA, 19403, USA
| | - Charles G Ledonio
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA, 19403, USA
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34
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Does the accuracy of pedicle screw placement differ between the attending surgeon and resident in navigated robotic-assisted minimally invasive spine surgery? J Robot Surg 2019; 14:567-572. [PMID: 31542860 PMCID: PMC7347677 DOI: 10.1007/s11701-019-01019-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/28/2019] [Indexed: 10/27/2022]
Abstract
Robotic assistance with integrated navigation is an area of high interest for improving the accuracy of minimally invasive pedicle screw placement. This study analyzes the accuracy of pedicle screw placement between an attending spine surgeon and a resident by comparing the left and right sides of the first 101 consecutive cases using navigated robotic assistance in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed. One attending spine surgeon and one resident performed pedicle screw placement consistently on either the left or right side (researchers were blinded). A CT-based Gertzbein and Robbins system (GRS) was used to classify pedicle screw accuracy, with grade A or B considered accurate. There were 630 consecutive lumbosacral pedicle screws placed. Thirty screws (5 patients) were placed without the robot due to surgeon discretion. Of the 600 pedicle screws inserted by navigated robotic guidance (101 patients), only 1.5% (9/600) were repositioned intraoperatively. Based on the GRS CT-based grading of pedicle breach, 98.67% (296/300) of left-side screws were graded A or B, 1.3% (4/300) were graded C, and 0% (0/300) were graded D. For the right-side screws, 97.67% (293/300) were graded A or B, 1.67% (5/300) were graded C, and 0.66% (2/300) were graded D. This study demonstrated a high level of accuracy (based on GRS) with no significant differences between the left- and right-side pedicle screw placements (98.67% vs. 97.67%, respectively) in the clinical use of navigated, robot-assisted surgery.
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