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Stewart JJ, Zhao DY, Pivazyan G, Gensler R, Voyadzis JM. Minimally invasive robot-assisted direct pars repair: illustrative cases. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE2415. [PMID: 39250836 PMCID: PMC11404107 DOI: 10.3171/case2415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/30/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Robot-assisted techniques are increasingly integrated into the field of spine surgery, with the potential benefits of increased accuracy and reduced radiation exposure. The objective of this study was to describe the technique of minimally invasive robot-assisted direct pars repair with 2 case illustrations. OBSERVATIONS An 18-year-old male and a 42-year-old male, both with bilateral L5 spondylolysis, underwent successful minimally invasive L5 direct pars repairs with robotic assistance after conservative measures failed, and their cases are presented herein. LESSONS A robot-assisted direct pars repair is a safe and effective technique for treating bilateral lumbar spondylolysis. The integration of robot-assisted techniques in spine surgery has the potential to improve outcomes, decrease surgical time, and reduce the amount of radiation exposure to operating room staff. https://thejns.org/doi/10.3171/CASE2415.
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Affiliation(s)
- Jeffrey J Stewart
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - David Y Zhao
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Gnel Pivazyan
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Ryan Gensler
- Georgetown University School of Medicine, Washington, DC
| | - Jean-Marc Voyadzis
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
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Gewiess J, Roth YE, Heini P, Benneker LM, Albers CE. Transiliac-Transsacral Screw Fixation is Superior to Lumbopelvic Stabilization in the Treatment of Minimally Displaced Sacral H-/U-Type Fragility Fractures. Global Spine J 2024:21925682241268141. [PMID: 39058691 DOI: 10.1177/21925682241268141] [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: 07/28/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To compare the outcomes and complications of transiliac-transsacral screw fixation (TIS) and lumbopelvic fixation (LPS), the 2 most common fixation methods for nondisplaced and minimally displaced H-/U- type sacral fragility fractures. METHODS Medical records of patients treated with TIS or LPS for nondisplaced and minimally displaced H-/U-type sacral fragility fractures at 2 level A trauma centers between 2012 and 2022 were analyzed. Postoperative low back pain and mobility levels were assessed as primary outcomes before discharge and at 6 weeks and 6 months postoperatively. Surgery time, blood loss, and surgical complication rates were assessed as secondary outcomes. Statistical analyses consisted of Fisher's exact tests for frequency distributions and Mann-Whitney-U tests and t-tests for group comparisons. RESULTS 52 patients undergoing TIS (mean age: 78 ± 9 years) and 36 patients undergoing LPS (74 ± 10 years) with no discrepancy in demographic parameters were identified. There were no differences in low back pain levels between the 2 groups before surgery, before discharge, at 6 weeks postoperatively, and at 6 months postoperatively (P > 0.05). There were no differences in mobility levels before surgery, before discharge, at 6 weeks postoperatively, and at 6 months postoperatively (P > 0.05). Duration of surgery was shorter after TIS (36 ± 13 min) compared to LPS (113 ± 31 min) (P < 0.0001). Intraoperative blood loss was lower for TIS (median <20 mL) compared to LPS (median 125 mL) (P < 0.0001). Postoperative radiculopathy was less frequent after TIS (n = 1) compared to LPS (n = 3) (P > 0.05). Median length of stay was shorter after TIS (11 days) compared to LPS (14 days) (P < 0.05). Rates of reoperations directly related to the index surgery were lower after TIS (n = 2) compared to LPS (n = 10) (P < 0.01). Implant failures were observed only after LPS (n = 1). CONCLUSION Patients with nondisplaced and minimally displaced H-/U- type sacral fragility fractures may preferably be treated using TIS, as it is equivalent to LPS in terms of low back pain reduction and restoration of mobility, but allows for shorter operative time, less blood loss and lower reoperation rates. Prospective randomized studies should be conducted to substantiate our findings and develop distinct treatment recommendations.
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Affiliation(s)
- Jan Gewiess
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ysaline Emilie Roth
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Paul Heini
- Orthopädie Sonnenhof, Bern, Switzerland
- Campus Stiftung Lindenhof Bern (Campus SLB), Bern, Switzerland
| | - Lorin M Benneker
- Orthopädie Sonnenhof, Bern, Switzerland
- Campus Stiftung Lindenhof Bern (Campus SLB), Bern, Switzerland
| | - Christoph Emanuel Albers
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Groisser BN, Thakur A, Hillstrom HJ, Adhiyaman A, Zucker C, Du J, Cunningham M, Hresko MT, Haddas R, Blanco J, Potter HG, Mintz DN, Breighner RE, Heyer JH, Widmann RF. Fully automated determination of robotic pedicle screw accuracy and precision utilizing computer vision algorithms. J Robot Surg 2024; 18:278. [PMID: 38960985 PMCID: PMC11222209 DOI: 10.1007/s11701-024-02001-w] [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: 04/27/2024] [Accepted: 05/27/2024] [Indexed: 07/05/2024]
Abstract
Historically, pedicle screw accuracy measurements have relied on CT and expert visual assessment of the position of pedicle screws relative to preoperative plans. Proper pedicle screw placement is necessary to avoid complications, cost and morbidity of revision procedures. The aim of this study was to determine accuracy and precision of pedicle screw insertion via a novel computer vision algorithm using preoperative and postoperative computed tomography (CT) scans. Three cadaveric specimens were utilized. Screw placement planning on preoperative CT was performed according to standard clinical practice. Two experienced surgeons performed bilateral T2-L4 instrumentation using robotic-assisted navigation. Postoperative CT scans of the instrumented levels were obtained. Automated segmentation and computer vision techniques were employed to align each preoperative vertebra with its postoperative counterpart and then compare screw positions along all three axes. Registration accuracy was assessed by preoperatively embedding spherical markers (tantalum beads) to measure discrepancies in landmark alignment. Eighty-eight pedicle screws were placed in 3 cadavers' spines. Automated registrations between pre- and postoperative CT achieved sub-voxel accuracy. For the screw tip and tail, the mean three-dimensional errors were 1.67 mm and 1.78 mm, respectively. Mean angular deviation of screw axes from plan was 1.58°. For screw mid-pedicular accuracy, mean absolute error in the medial-lateral and superior-inferior directions were 0.75 mm and 0.60 mm, respectively. This study introduces automated algorithms for determining accuracy and precision of planned pedicle screws. Our accuracy outcomes are comparable or superior to recent robotic-assisted in vivo and cadaver studies. This computerized workflow establishes a standardized protocol for assessing pedicle screw placement accuracy and precision and provides detailed 3D translational and angular accuracy and precision for baseline comparison.
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Affiliation(s)
- Benjamin N Groisser
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ankush Thakur
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Howard J Hillstrom
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Akshitha Adhiyaman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Colson Zucker
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jerry Du
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Matthew Cunningham
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - Ram Haddas
- University of Rochester Medical Center, Rochester, NY, USA
| | - John Blanco
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Hollis G Potter
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Douglas N Mintz
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ryan E Breighner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jessica H Heyer
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Roger F Widmann
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Tracey OC, Wisch JL, Adhiyaman A, Zucker CP, Widmann RF, Heyer JH. Minimally Invasive Placement of Pedicle Screws Using Robotic-Assisted Navigation and Magnetically Controlled Growing Rods in a Patient with Early-Onset Scoliosis: Technical Note and Case Report. J Orthop Case Rep 2024; 14:71-76. [PMID: 39035383 PMCID: PMC11258716 DOI: 10.13107/jocr.2024.v14.i07.4580] [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: 04/13/2024] [Revised: 05/26/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Early-onset scoliosis (EOS) refers to spinal curvature exceeding ten degrees in the coronal plane in patients under 10 years old. When non-operative management fails to control the curvature, surgical intervention may be indicated. In younger patients, growth-friendly instrumentation may be necessary to allow for continued spinal growth while controlling the curve, which includes magnetically control growing rods (MCGR). This paper is the first description of robotic-assisted navigation in a patient with EOS undergoing MCGR insertion with the minimally invasive placement of pedicle screws. The benefits of a trans-muscular robotic-assisted technique include minimizing the risk of autofusion of the non-instrumented area. Case Report The 7-year-old female patient with vertebral, anal, cardiac, tracheoesophageal, renal, esophageal, and limb anomalies and a complex medical history, presented with progressive, early-onset syndromic scoliosis. She underwent various surgeries in infancy for imperforate anus, colonic atresia, and malrotation, among other issues. Over time her curve worsened, reaching 71° by age seven. Insertion of MCGR was recommended and successfully performed using robotic-assisted navigation for placement of pedicle screws. Immediately post-operatively, the patients' major curve improved to 15°. She was discharged home without complications on post-operative day 4. Conclusion This case study exemplifies the success and safety of growth-friendly instrumentation using robotic-assisted navigation for the placement of pedicle screws.
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Affiliation(s)
- Olivia C Tracey
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, New York, United States of America
| | - Jenna L Wisch
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, New York, United States of America
| | - Akshitha Adhiyaman
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, New York, United States of America
| | - Colson P Zucker
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, New York, United States of America
| | - Roger F Widmann
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, New York, United States of America
| | - Jessica H Heyer
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, New York, United States of America
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Zhan X, Gao F, Yang Y, Tsai T, Wan Z, Yu Y. Effect of Insertional Direction of Pedicle Screw on Screw Loosening: A Biomechanical Study on Synthetic Bone Vertebra under a Physiology-like Load. Orthop Surg 2024; 16:1461-1472. [PMID: 38714346 PMCID: PMC11144517 DOI: 10.1111/os.14080] [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: 02/05/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/09/2024] Open
Abstract
OBJECTIVES It is now understood that pedicle screw loosening at the implant-bone interface can lead to poor screw-bone interface purchase and decreased fixation stability. Previous biomechanical tests used cadaveric vertebrae and pull-out or torque loads to assess the effect of the insertional direction of pedicle screws on screw loosening. However, these tests faced challenges in matching biomechanical differences among specimens and simulating in vivo loads applied on pedicle screws. This study aimed to evaluate the effect of the insertional direction of pedicle screws on screw loosening using tension-compression-bending loads and synthetic bone vertebrae. METHODS Polyaxial pedicle screws were inserted into nine synthetic bone vertebrae in three directions (three samples per group): cranial, parallel, and caudad (-10°, 0°, +10° of the pedicle screw rod to the upper plane of the vertebra, respectively). Pedicle screws in the vertebrae were loaded using a polyethylene block connected to a material testing machine. Tension-compression-bending loads (100N-250N) with 30,000 cycles were applied to the pedicle screws, and displacements were recorded and then cycle-displacement curve was drawn based on cycle number. Micro-CT scans were performed on the vertebrae after removing the pedicle screws to obtain images of the screw hole, and the screw hole volume was measured using imaging analysis software. Direct comparison of displacements was conducted via cycle-displacement curve. Screw hole volume was analyzed using analysis of variance. The correlation between the displacement, screw hole volume and the direction of pedicle screw was assessed by Spearman correlation analysis. RESULTS The smallest displacements were observed in the caudad group, followed by the parallel and cranial groups. The caudad group had the smallest screw hole volume (p < 0.001 and p = 0.009 compared to the cranial and parallel groups, respectively), while the volume in the parallel group was greater than that in the cranial group (p = 0.003). Correlation analysis revealed that the insertional direction of the pedicle screw was associated with the displacement (p = -0.949, p < 0.001) and screw hole volume (p = -0.944, p < 0.001). CONCLUSION Strong correlations were found between the insertional direction of the pedicle screw and relevant parameters, including displacement and screw hole volume. Pedicle screw insertion in the caudad direction resulted in the least pedicle screw loosening.
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Affiliation(s)
- Xuqiang Zhan
- Department of Spine SurgeryTongji Hospital, School of Medicine, Tongji UniversityShanghaiChina
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine SurgeryTongji Hospital, School of Medicine, Tongji UniversityShanghaiChina
| | - Feng Gao
- Department of Spine SurgeryTongji Hospital, School of Medicine, Tongji UniversityShanghaiChina
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine SurgeryTongji Hospital, School of Medicine, Tongji UniversityShanghaiChina
- Yuyao Maternity and Child Health Care Hospital (Yuyao Second People's Hospital)ZhejiangChina
| | - Yangyang Yang
- School of Biomedical Engineering & Med‐X Research Institute, Shanghai Jiao Tong UniversityShanghaiChina
| | - Tsung‐Yuan Tsai
- School of Biomedical Engineering & Med‐X Research Institute, Shanghai Jiao Tong UniversityShanghaiChina
| | - Zongmiao Wan
- The First Affiliated Hospital of NanChang UniversityNanchangChina
| | - Yan Yu
- Department of Spine SurgeryTongji Hospital, School of Medicine, Tongji UniversityShanghaiChina
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine SurgeryTongji Hospital, School of Medicine, Tongji UniversityShanghaiChina
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Leblond L, Godio-Raboutet Y, Glard Y, La Greca R, Clement T, Evin M. Assessment of the tolerance angle for pedicle screw insertion. Med Biol Eng Comput 2024; 62:1265-1275. [PMID: 38177833 DOI: 10.1007/s11517-023-03002-x] [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: 09/08/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
Cannulation process intervenes before implantation of pedicle screw and depends on the surgeon's experience. A reliable experimental protocol has been developed for the characterization of the slipping behavior of the surgical tool on the cortical shell simulated by synthetic materials. Three types of synthetic foam samples with three different densities were tested using an MTS Acumen 3 A/T electrodynamic device with a tri-axis 3 kN Kistler load cell mounted on a surgical tool, moving at a constant rotational speed of 10° mm-1 and performing a three-step cannulation test. Cannulation angle varied between 10° and 30°. Synthetic samples were scanned after each tests, and cannulation coefficient associated to each perforation section was computed. Reproducibility tests resulted in an ICC for Sawbone samples of 0.979 (p < 0.001) and of 0.909 (p < 0.001) for Creaplast and Sawbone samples. Cannulation coefficient and maximum force in Z-axis are found the best descriptors of the perforation. Angular threshold for perforation prediction was found to be 17.5° with an area under the curve of the Receiver Operating Characteristic of 89.5%. This protocol characterizes the cannulation process before pedicle screw insertion and identifies the perforation tool angle until which the surgical tool slips on the cortical shell depending on bone quality.
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Affiliation(s)
- Lugdivine Leblond
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR, Faculté de Medecine Secteur-Nord, Aix-Marseille University, University of Gustave Eiffel, LBA, Marseille, France
| | - Yves Godio-Raboutet
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR, Faculté de Medecine Secteur-Nord, Aix-Marseille University, University of Gustave Eiffel, LBA, Marseille, France
| | - Yann Glard
- Department of Paediatric Orthopaedics, Saint Joseph Hospital, Marseille, France
| | - Raphael La Greca
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR, Faculté de Medecine Secteur-Nord, Aix-Marseille University, University of Gustave Eiffel, LBA, Marseille, France
| | - Thomas Clement
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR, Faculté de Medecine Secteur-Nord, Aix-Marseille University, University of Gustave Eiffel, LBA, Marseille, France
| | - Morgane Evin
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR, Faculté de Medecine Secteur-Nord, Aix-Marseille University, University of Gustave Eiffel, LBA, Marseille, France.
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Smith AF, Lendhey M, Winfield J, Mahoney JM, Bucklen BS, Carlson JB. A feasibility cadaver study for placing screws in various pelvic osseous fracture pathways using a robotic arm. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1457-1463. [PMID: 38240824 DOI: 10.1007/s00590-023-03821-6] [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: 10/25/2023] [Accepted: 12/20/2023] [Indexed: 04/02/2024]
Abstract
INTRODUCTION The use of a robotic system for the placement of pedicle screws in spine surgeries is well documented in the literature. However, there is only a single report in the United States describing the use of a robotic system to place two screws in osseous fixation pathways (OFPs) commonly used in the treatment of pelvic and acetabular fractures in a simulated bone model. The purpose of this study was to demonstrate the use of a robotic system to place screws in multiple, clinically relevant OFPs in a cadaveric model and to quantitatively measure accuracy of screw placement relative to the preoperative plan. METHODS A single cadaveric specimen was obtained for the purpose of this study. All surrounding soft tissues were left intact. Screws were placed in OFPs, namely iliosacral (IS), trans-sacral (TS), Lateral Compression-II (LC-II), antegrade anterior column (AC) and antegrade posterior column (PC) of the right hemipelvis using standard, fluoroscopically assisted percutaneous or mini-open technique. Following the placement of screws into the right hemipelvis using standard techniques, screws were planned and placed in the same OFPs of the contralateral hemipelvis using the commercially available ExcelsiusGPS® robotic system (Globus Medical Inc., Audubon, PA). After robotic-assisted screw placement, a post-procedure CT scan was obtained to evaluate actual screw placement against the pre-procedure plan. A custom-made image analysis program was devised to measure screw tip/tail offset and angular offset on axial and sagittal planes. RESULTS For different OFPs, the mean tip offset, tail offset and angular offsets were 1.6 ± 0.9 mm (Range 0.0-3.6 mm), 1.4 ± 0.4 mm (Range 0.3-2.5 mm) and 1.1 ± 0.4° (Range 0.5-2.1), respectively. CONCLUSION In this feasibility study, surgeons were able to place screws into the clinically relevant fracture pathways of the pelvis using ExcelsiusGPS® for robotic-assisted surgery. The measured accuracy was encouraging; however, further investigation is needed to demonstrate that robotic-assisted surgery can be used to successfully place the screws in the bony corridors of the pelvis to treat traumatic pelvic injuries.
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Affiliation(s)
- Austin F Smith
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | - Matin Lendhey
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA
| | - Jalen Winfield
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Jonathan M Mahoney
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA.
- Biomechanics Research, Globus Medical, Inc., 2560 General Armistead Ave, Audubon, PA, 19403, USA.
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA
| | - Jon B Carlson
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
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Lakomkin N, Eastlack RK, Uribe JS, Park P, Ryu SI, Kretzer R, Mimran RI, Holman P, Veeravagu A, Hassanzadeh H, Johnson MM, Sullivan L, Clark A, Mundis GM. An Integrated 3-Dimentional Navigation System Increases the Accuracy, Efficiency, and Safety of Percutaneous Thoracolumbar Pedicle Screw Placement in Minimally Invasive Approaches: A Randomized Cadaveric Study. Global Spine J 2024:21925682231224394. [PMID: 38165219 DOI: 10.1177/21925682231224394] [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: 01/03/2024] Open
Abstract
STUDY DESIGN Cadaveric study. OBJECTIVES The purpose of this study was to compare a novel, integrated 3D navigational system (NAV) and conventional fluoroscopy in the accuracy, efficiency, and radiation exposure of thoracolumbar percutaneous pedicle screw (PPS) placement. METHODS Twelve skeletally mature cadaveric specimens were obtained for twelve individual surgeons. Each participant placed bilateral PS at 11 segments, from T8 to S1. Prior to insertion, surgeons were randomized to the sequence of techniques and the side (left or right). Following placement, a CT scan of the spine was obtained for each cadaver, and an independent reviewer assessed the accuracy of screw placement using the Gertzbein grading system. Outcome metrics of interest included a comparison of breach incidence/severity, screw placement time, total procedure time, and radiation exposure between the techniques. Bivariate statistics were employed to compare outcomes at each level. RESULTS A total of 262 screws (131 using each technique) were placed. The incidence of cortical breaches was significantly lower with NAV compared to FG (9% vs 18%; P = .048). Of breaches with NAV, 25% were graded as moderate or severe compared to 39% in the FG subgroup (P = .034). Median time for screw placement was significantly lower with NAV (2.7 vs 4.1 min/screw; P = .012), exclusive of registration time. Cumulative radiation exposure to the surgeon was significantly lower for NAV-guided placement (9.4 vs 134 μGy, P = .02). CONCLUSIONS The use of NAV significantly decreased the incidence of cortical breaches, the severity of screw breeches, screw placement time, and radiation exposure to the surgeon when compared to traditional FG.
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Affiliation(s)
| | - Robert K Eastlack
- Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Paul Park
- Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, TN, USA
| | - Stephen I Ryu
- Department of Neurosurgery, Sutter Health, Palo Alto, CA, USA
| | - Ryan Kretzer
- Department of Neurosurgery, Western Neuro, Phoenix, AZ, USA
| | - Ronnie I Mimran
- Department of Neurosurgery, Sutter Health, Palo Alto, CA, USA
| | - Paul Holman
- Department of Neurosurgery, Houston Methodist, Houston, TX, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Michele M Johnson
- Department of Neurosurgery, Atlanta Brain and Spine, Atlanta, GA, USA
| | - Linda Sullivan
- Medical writing and Biostatistics, NuVasive, San Diego, CA, USA
| | - Aaron Clark
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Gregory M Mundis
- Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
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Anderson W, Ponce FA, Kinsman MJ, Sani S, Hwang B, Ghinda D, Kogan M, Mahoney JM, Amin DB, Van Horn M, McGuckin JP, Razo-Castaneda D, Bucklen BS. Robotic-Assisted Navigation for Stereotactic Neurosurgery: A Cadaveric Investigation of Accuracy, Time, and Radiation. Oper Neurosurg (Hagerstown) 2023; 26:01787389-990000000-00991. [PMID: 38054727 PMCID: PMC11008650 DOI: 10.1227/ons.0000000000001024] [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: 08/14/2023] [Accepted: 10/18/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite frequent use, stereotactic head frames require manual coordinate calculations and manual frame settings that are associated with human error. This study examines freestanding robot-assisted navigation (RAN) as a means to reduce the drawbacks of traditional cranial stereotaxy and improve targeting accuracy. METHODS Seven cadaveric human torsos with heads were tested with 8 anatomic coordinates selected for lead placement mirrored in each hemisphere. Right and left hemispheres of the brain were randomly assigned to either the traditional stereotactic arc-based (ARC) group or the RAN group. Both target accuracy and trajectory accuracy were measured. Procedural time and the radiation required for registration were also measured. RESULTS The accuracy of the RAN group was significantly greater than that of the ARC group in both target (1.2 ± 0.5 mm vs 1.7 ± 1.2 mm, P = .005) and trajectory (0.9 ± 0.6 mm vs 1.3 ± 0.9 mm, P = .004) measurements. Total procedural time was also significantly faster for the RAN group than for the ARC group (44.6 ± 7.7 minutes vs 86.0 ± 12.5 minutes, P < .001). The RAN group had significantly reduced time per electrode placement (2.9 ± 0.9 minutes vs 5.8 ± 2.0 minutes, P < .001) and significantly reduced radiation during registration (1.9 ± 1.1 mGy vs 76.2 ± 5.0 mGy, P < .001) compared with the ARC group. CONCLUSION In this cadaveric study, cranial leads were placed faster and with greater accuracy using RAN than those placed with conventional stereotactic arc-based technique. RAN also required significantly less radiation to register the specimen's coordinate system to the planned trajectories. Clinical testing should be performed to further investigate RAN for stereotactic cranial surgery.
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Affiliation(s)
- William Anderson
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Francisco A. Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael J. Kinsman
- Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Hwang
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
- Current Affiliation: Orange County Neurosurgical Associates, Laguna Hills, California, USA
| | - Diana Ghinda
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michael Kogan
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Jonathan M. Mahoney
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania, USA
| | - Dhara B. Amin
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania, USA
| | - Margaret Van Horn
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania, USA
| | - Joshua P. McGuckin
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania, USA
| | - Dominic Razo-Castaneda
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Brandon S. Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, Pennsylvania, USA
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10
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Leblond L, Godio-Raboutet Y, Tomi F, Glard Y, La Greca R, Clement T, Evin M. Sliding on cortical shell: Biomechanical characterization of the vertebral cannulation for pedicle screw insertion. Clin Biomech (Bristol, Avon) 2023; 110:106102. [PMID: 37769380 DOI: 10.1016/j.clinbiomech.2023.106102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Pedicular screws pull-out has been well studied unlike their insertion. A need for characterizing cannulation before pedicle screw implantation is highlighted in literature and offers promising prospects for future intra-operation instrumentation. A reliable cannulation protocol for ex-vivo testing in swine and cadaver vertebrae is presented in this work to predict extra pedicular perforation. METHODS An MTS Acumen 3 A/T electrodynamic device, with a tri-axis 3 kN Kistler load cell mounted on a surgical tool was used to reproduce surgeon's gesture by moving at a constant rotational speed of 10°/mm and performing a three-section test. Perforation of the pedicle's cortical shell was planned through a design of experiment on the surgical tool angle at the entry point. Samples were scanned before and after mechanical tests and reproducibility of the protocol was tested on synthetic foam. Computation of the angle between cannulation tool and pedicle cortical shell was performed as well as cannulation coefficient of each perforation section. FINDINGS A total of 68 pedicles were tested: 19 perforated and 21 non-perforated human pedicles, 17 perforated and 16 non-perforated swine pedicles. The reproducibility of the protocol for cannulation coefficient computation resulted in an intraclass correlation coefficient of 0.979. Cannulation coefficients results presented variability within spinal levels as well as between swine and human model. Correlation between bone density and cannulation coefficient was found significant (p < 0.005). Torque measurement was found to be the best predictor of perforation. Threshold of angle for prediction of perforation was found to be 21.7°. INTERPRETATION Characterizing pedicle cannulation enables to predict extra pedicular perforation. Influence of bone mineral density and patient-specific morphology on pedicle cannulation has been highlighted together with a comparison of swine and cadaver models.
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Affiliation(s)
| | | | - Florent Tomi
- Aix Marseille Univ. Univ Gustave Eiffel, LBA, Marseille, France
| | - Yann Glard
- Department of Paediatric Orthopaedics, Saint Joseph Hospital, Marseille, France
| | | | - Thomas Clement
- Aix Marseille Univ. Univ Gustave Eiffel, LBA, Marseille, France
| | - Morgane Evin
- Aix Marseille Univ. Univ Gustave Eiffel, LBA, Marseille, France.
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11
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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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12
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Cao B, Yuan B, Xu G, Zhao Y, Sun Y, Wang Z, Zhou S, Xu Z, Wang Y, Chen X. A Pilot Human Cadaveric Study on Accuracy of the Augmented Reality Surgical Navigation System for Thoracolumbar Pedicle Screw Insertion Using a New Intraoperative Rapid Registration Method. J Digit Imaging 2023; 36:1919-1929. [PMID: 37131064 PMCID: PMC10406793 DOI: 10.1007/s10278-023-00840-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023] Open
Abstract
To evaluate the feasibility and accuracy of AR-assisted pedicle screw placement using a new intraoperative rapid registration method of combining preoperative CT scanning and intraoperative C-arm 2D fluoroscopy in cadavers. Five cadavers with intact thoracolumbar spines were employed in this study. Intraoperative registration was performed using anteroposterior and lateral views of preoperative CT scanning and intraoperative 2D fluoroscopic images. Patient-specific targeting guides were used for pedicle screw placement from Th1-L5, totaling 166 screws. Instrumentation for each side was randomized (augmented reality surgical navigation (ARSN) vs. C-arm) with an equal distribution of 83 screws in each group. CT was performed to evaluate the accuracy of both techniques by assessing the screw positions and the deviations between the inserted screws and planned trajectories. Postoperative CT showed that 98.80% (82/83) screws in ARSN group and 72.29% (60/83) screws in C-arm group were within the 2-mm safe zone (p < 0.001). The mean time for instrumentation per level in ARSN group was significantly shorter than that in C-arm group (56.17 ± 3.33 s vs. 99.22 ± 9.03 s, p < 0.001). The overall intraoperative registration time was 17.2 ± 3.5 s per segment. AR-based navigation technology can provide surgeons with accurate guidance of pedicle screw insertion and save the operation time by using the intraoperative rapid registration method of combining preoperative CT scanning and intraoperative C-arm 2D fluoroscopy.
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Affiliation(s)
- Bing Cao
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Bo Yuan
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Guofeng Xu
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Yin Zhao
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Yanqing Sun
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Zhiwei Wang
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Shengyuan Zhou
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Zheng Xu
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China
| | - Yao Wang
- Linyan Medical Technology Company Limited, 528 Ruiqing Road, Pudong New District, Shanghai, China
| | - Xiongsheng Chen
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China.
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13
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Wang S, Zhang W, Sun J, Wang Y, Fan J, Yu Y, Zhao F, Gao J, Shi J, Guo Y. Detection of Common Anatomical Landmarks and Vertical Trajectories for Freehand Pedicle Screw Placement. Orthop Surg 2023. [PMID: 37183354 DOI: 10.1111/os.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE It is clinically important for pedicle screws to be placed quickly and accurately. Misplacement of pedicle screws results in various complications. However, the incidence of complications varies greatly due to the different professional titles of physicians and surgical experience. Therefore, physicians must minimize pedicle screw dislocation. This study aims to compare the three nail placement methods in this study, and explore which method is the best for determining the anatomical landmarks and vertical trajectories. METHODS This study involved 70 patients with moderate idiopathic scoliosis who had undergone deformity correction surgery between 2018 and 2021. Two spine surgeons used three techniques (preoperative computed tomography scan [CTS], visual inspection-X-freehand [XFH], and intraoperative detection [ID] of anatomical landmarks) to locate pedicle screws. The techniques used include visual inspection for 287 screws in 21 patients, preoperative planning for 346 screws in 26 patients, and intraoperative probing for 309 screws in 23 patients. Observers assessed screw conditions based on intraoperative CT scans (Grade A, B, C, D). RESULTS There were no significant differences between the three groups in terms of age, sex, and degree of deformity. We found that 68.64% of screws in the XFH group, 67.63% in the CTS group, and 77.99% in the ID group were placed within the pedicle margins (grade A). On the other hand, 6.27% of screws in the XFH group, 4.33% in the CTS group, and 6.15% in the ID group were considered misplaced (grades C and D). The results show that the total amount of upper thoracic pedicle screws was fewer, meanwhile their placement accuracy was lower. The three methods used in this study had similar accuracy in intermediate physicians (P > 0.05). Compared with intermediate physicians, the placement accuracy of three techniques in senior physicians was higher. The intraoperative detection group was better than the other two groups in the good rate and accuracy of nail placement (P < 0.05). CONCLUSION Intraoperative common anatomical landmarks and vertical trajectories were beneficial to patients with moderate idiopathic scoliosis undergoing surgery. It is an optimal method for clinical application.
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Affiliation(s)
- Shunmin Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
- 910 Hospital of China Joint Logistics Support Force, Quanzhou, China
| | - Weihang Zhang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yuan Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianping Fan
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yaping Yu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Feng Zhao
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
- 910 Hospital of China Joint Logistics Support Force, Quanzhou, China
| | - Jie Gao
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
- 910 Hospital of China Joint Logistics Support Force, Quanzhou, China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yongfei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
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14
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Beucler N. Comparison between cervical lateral mass screw and cervical pedicle screw surgery. Neurosurg Rev 2023; 46:78. [PMID: 36977816 DOI: 10.1007/s10143-023-01985-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Nathan Beucler
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 Boulevard Sainte-Anne, 83800, Toulon Cedex 9, France.
- Ecole du Val-de-Grâce, French Military Health Service Academy, 1 Place Alphonse Laveran, Paris 5, 75230, France.
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15
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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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16
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Gabrovsky N, Ilkov P, Laleva M. Cirq Robotic Assistance for Thoracolumbar Pedicle Screw Placement: Overcoming the Disadvantages of Minimally Invasive Spine Surgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:389-392. [PMID: 38153498 DOI: 10.1007/978-3-031-36084-8_59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Various minimally invasive spine surgery (MISS) techniques have been developed with the goal of reducing approach-related soft-tissue trauma and its associated complications. However, there is still a debate on some of the potential drawbacks of MISS techniques, such as their longer operating times and increased intraoperative radiation. A solution to these disadvantages could be the implementation of new technologies, such as computer-assisted navigation (CAN) and surgical robotics. We compare the standard fluoroscopy MISS technique with our experience with time per screw and X-ray exposure for pedicle screw placement using the Brainlab Cirq passive robotic arm assistance coupled with the Brainlab Curve navigation system. METHODS In the Cirq robot-assisted group (Group I), 109 screws were placed in 24 prospectively analyzed patients. In the fluoroscopy-guided group, 108 screws inserted into 20 consecutive patients were analyzed retrospectively (Group II). The duration of surgery, the time to place one screw, the X-ray exposition, and the pedicle screw accuracy for each patient were recorded and reviewed. RESULTS In total, 217 screws were analyzed. The treated levels ranged from T10 to S1. In Group I, 104 screws were grade A (95.4%) and five were grade B (4.6%). In Group II, 96 screws were grade A (88.89%); ten were grade B (9.26%); one was grade C (0.93%), and one was grade D (0.93%). While the screws placed by using the Cirq system were more accurate overall, there was no statistical significance when the two groups were compared, p = 0.3724. There was no significant difference in radiation exposure between the two groups, p = 0.5482; however the radiation exposure for the surgeon was very limited with the Cirq system. There was a significant reduction in the operation length (p = 0.0183) and the time per screw (p < 0.0001) for Group I. CONCLUSIONS The CAN systems and emerging robotic platforms have the potential to diminish the main disadvantages of MISS techniques-longer operation times and X-ray exposure, at least for the surgical team.
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Affiliation(s)
- Nikolay Gabrovsky
- Department of Neurosurgery, University Hospital "Pirogov", Sofia, Bulgaria
| | - Petar Ilkov
- Department of Neurosurgery, University Hospital "Pirogov", Sofia, Bulgaria
| | - Maria Laleva
- Department of Neurosurgery, University Hospital "Pirogov", Sofia, Bulgaria
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17
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Zhou S, Li B, Wang P, Xu M, Zhao J, Duan S, Zhu Z, Xu W, Xiao J. Robot and working tube-assisted invasion-controlled surgery for spinal metastases. Front Surg 2023; 10:1041562. [PMID: 36911610 PMCID: PMC9998543 DOI: 10.3389/fsurg.2023.1041562] [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] [Received: 09/11/2022] [Accepted: 01/25/2023] [Indexed: 03/14/2023] Open
Abstract
Objective This study aims to highlight the use of robots in surgery and that of tube-assisted minimally invasive surgery for spinal metastases, as well as elaborate on the concept of invasion-controlled surgery (ICS). Summary of background Many patients with spinal metastasis cancer cannot afford serious complications when undergoing traditional open surgery because of their poor physical condition. Robots and minimally invasive technology have been introduced into the field of spine surgery and they have shown significant advantages. Methods Six patients who underwent robot and working tube-assisted ICS for spinal metastases. Relevant demographic, medical, surgical, and postoperative data were collected from medical records and analyzed. Results Mean operative time was 3.8 h and the mean length of the surgical incision was 4.9 cm. The mean estimated blood loss was 400 ml. The mean bedtime and hospital length of stay were 3.2 days and 6.5 days, respectively. No obvious complications were reported during treatment. The mean accuracy of screw placement was 98%. The mean time for further system treatment after surgery was 5.8 days. All patients experienced significant pain relief. The mean preoperative visual analog scale (VAS) was 7.83 points. The mean VAS at 1 day, 1 week, and 1 month after surgery were 2.83, 1.83, and 1.17 points, respectively. Frankel grade was improved in five of six patients. One patient preoperatively with Frankel grade D was the same postoperatively. Conclusion The concept of ICS is suitable for patients with spinal metastases. Robot and working tube-assisted ICS for spinal metastases is one of the safest and most effective treatment methods.
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Affiliation(s)
- Shangbin Zhou
- Department of Orthorpedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai, China.,Naval Medical Center, Naval Military Medical University, Shanghai, China
| | - Bo Li
- Department of Orthorpedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Pengru Wang
- Department of Orthorpedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Meiling Xu
- Department of Radiology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Jian Zhao
- Department of Orthorpedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Shujie Duan
- Department of Orthorpedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Zhipeng Zhu
- Department of Orthorpedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Wei Xu
- Department of Orthorpedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Jianru Xiao
- Department of Orthorpedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
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18
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Hamilton T, Hadi M, Simo L, Chang V. Commentary: Sacroiliac Joint Fusion Using Robotic Navigation: Technical Note and Case Series. Oper Neurosurg (Hagerstown) 2022; 23:e209-e210. [PMID: 35972120 DOI: 10.1227/ons.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Travis Hamilton
- Department of Neurosurgery, Henry Ford Health, Detroit, Michigan, USA
| | - Moustafa Hadi
- College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Leticia Simo
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Health, Detroit, Michigan, USA
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Sivaganesan A, Kim C, Kiran Alluri R, Vaishnav AS, Qureshi S. Advanced Technologies for Outpatient Lumbar Fusion: Barriers and Opportunities. Int J Spine Surg 2022; 16:S37-S43. [PMID: 35831061 PMCID: PMC9808792 DOI: 10.14444/8275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In recent years, there has been increasing interest in outpatient spine surgery. Minimally invasive techniques have created an opportunity for ambulatory lumbar fusion, and these techniques increasingly involve advanced technologies such as navigation and robotics. OBJECTIVE To explore the barriers, advantages, and future predictions for such technology in the context of outpatient lumbar fusions. METHODS This is a narrative review of studies examining the advantages, limitations, and cost-effectiveness of navigation and spinal robotics in conjunction with the outcomes and costs of outpatient lumbar fusion. RESULTS Outpatient lumbar fusion is a growing trend with ample evidence of its safety, favorable patient outcomes, and cost savings. Navigation and spinal robotics are associated with improved instrumentation accuracy and fewer complications, and the long-term cost savings can make these technologies financially practical in the outpatient setting. Future capabilities with robotics will only increase their value. CONCLUSIONS Advanced technologies such as navigation and robotics are strategic long-term investments in the context of outpatient lumbar fusion. CLINICAL RELEVANCE The favorable outcomes and costs associated with navigation and robotics will be relevant to any spine surgeon interested in developing an outpatient lumbar fusion program. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Ahilan Sivaganesan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Choll Kim
- Excel Spine Center, San Diego, CA, USA
| | | | | | - Sheeraz Qureshi
- Hospital for Special Surgery, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA, Sheeraz Qureshi, Weill Cornell Medical College, 535 E 70th St, New York, NY 10021, USA;
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20
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Lee NJ, Leung E, Buchanan IA, Geiselmann M, Coury JR, Simhon ME, Zuckerman S, Buchholz AL, Pollina J, Jazini E, Haines C, Schuler TC, Good CR, Lombardi J, Lehman RA. A multicenter study of the 5-year trends in robot-assisted spine surgery outcomes and complications. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:9-20. [PMID: 35441099 PMCID: PMC8990386 DOI: 10.21037/jss-21-102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/12/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND Although a growing amount of literature that suggests robots are safe and can achieve comparable outcomes to conventional techniques, much of this literature is limited by small sample sizes and single-surgeon or single center series. Furthermore, it is unclear what the impact of robotic technology has made on operative and clinical outcomes over time. This is the first and largest multicenter study to examine the trends in outcomes and complications after robot-assisted spine surgery over a 5-year period. METHODS Adult (≥18 years old) patients who underwent spine surgery with robot-assistance between 2015 and 2019 at four unique spine centers. The robotic systems used included the Mazor Renaissance, Mazor X, and Mazor Stealth Edition. Patients with incomplete data were excluded from this study. The minimum follow-up was 90 days. RESULTS A total of 722 adult patients were included (117 Renaissance, 477 X, 128 Stealth). Most patient and operative factors (e.g., sex, tobacco status, total instrumented levels, and pelvic fixation,) were similar across the years. Mean ± standard deviation Charlson comorbidity index (CCI) was 1.5±1.5. The most commonly reported diagnoses included high grade spondylolisthesis (40.6%), degenerative disc disease (18.4%), and degenerative scoliosis (17.6%). Mean (standard deviation) number of instrumented levels was 3.8±3.4. From 2015 to 2019, average robot time per screw improved from 7.2 to 5.5 minutes (P=0.004, R2=0.649). Average fluoroscopy time per screw improved from 15.2 to 9.4 seconds (P=0.002). Rates of both intraoperative screw exchange for misplaced screw (2015-2016: 2.7%, 2019: 0.8%, P=0.0115, R2=0.1316) and robot abandonment (2015-2016: 7.1%, 2019: 1.1%, P=0.011, R2=0.215) improved significantly over time. The incidence of other intraoperative complications (e.g., dural tear, loss of motor/sensory function, blood transfusion) remained consistently low, but similar throughout the years. The length of stay (LOS) decreased by nearly 1 day from 2015 to 2019 (P=0.007, R2=0.779). 90-day reoperation rates did not change significantly. CONCLUSIONS At four institutions among seven surgeons, we demonstrate robot screw accuracy, reliability, operative efficiency, and radiation exposure improved significantly from 2015 to 2019. 90-day complication rates remained low and LOS decreased significantly with time. These findings further validate continued usage of robot-assisted spine surgery and the path toward improved value-based care.
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Affiliation(s)
- Nathan J. Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Eric Leung
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ian A. Buchanan
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Matthew Geiselmann
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Josephine R. Coury
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Matthew E. Simhon
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Scott Zuckerman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, 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 Lombardi
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ronald A. Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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21
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McVeigh L, Anokwute MC, Huh A, Blucker N, Lane BC. Anterior Lumbar Interbody Fusion With Robotic-Assisted Percutaneous Screw Placement: A Case Report. Cureus 2022; 14:e22573. [PMID: 35355535 PMCID: PMC8957393 DOI: 10.7759/cureus.22573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/05/2022] Open
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22
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Lee NJ, Buchanan IA, Zuckermann SL, Boddapati V, Mathew J, Geiselmann M, Park PJ, Leung E, Buchholz AL, Khan A, Mullin J, Pollina J, Jazini E, Haines C, Schuler TC, Good CR, Lombardi JM, Lehman RA. What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients. Spine (Phila Pa 1976) 2022; 47:42-48. [PMID: 34091564 PMCID: PMC8654274 DOI: 10.1097/brs.0000000000004132] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter cohort. OBJECTIVE To compare the robot time/screw, radiation exposure, robot abandonment, screw accuracy, and 90-day outcomes between robot-assisted percutaneous and robot-assisted open approach for short lumbar fusion (1- and 2-level). SUMMARY OF BACKGROUND DATA There is conflicting literature on the superiority of robot-assisted minimally invasive spine surgery to open techniques. A large, multicenter study is needed to further elucidate the outcomes and complications between these two approaches. METHODS We included adult patients (≥18 yrs old) who underwent robot-assisted short lumbar fusion surgery from 2015 to 2019 at four independent institutions. A propensity score matching algorithm was employed to control for the potential selection bias between percutaneous and open surgery. The minimum follow-up was 90 days after the index surgery. RESULTS After propensity score matching, 310 patients remained. The mean (standard deviation) Charlson comorbidity index was 1.6 (1.5) and 53% of patients were female. The most common diagnoses included high-grade spondylolisthesis (grade >2) (48%), degenerative disc disease (22%), and spinal stenosis (25%), and the mean number of instrumented levels was 1.5(0.5). The operative time was longer in the open (198 min) versus the percutaneous group (167 min, P value = 0.007). However, the robot time/screw was similar between cohorts (P value > 0.05). The fluoroscopy time/ screw for percutaneous (14.4 s) was longer than the open group (10.1 s, P value = 0.021). The rates for screw exchange and robot abandonment were similar between groups (P value > 0.05). The estimated blood loss (open: 146 mL vs. percutaneous: 61.3 mL, P value < 0.001) and transfusion rate (open: 3.9% vs. percutaneous: 0%, P value = 0.013) were greater for the open group. The 90-day complication rate and mean length of stay were not different between cohorts (P value > 0.05). CONCLUSION Percutaneous robot-assisted spine surgery may increase radiation exposure, but can achieve a shorter operative time and lower risk for intraoperative blood loss for short-lumbar fusion. Percutaneous approaches do not appear to have an advantage for other short-term postoperative outcomes. Future multicenter studies on longer fusion surgeries and the inclusion of patient-reported outcomes are needed.Level of Evidence: 3.
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Affiliation(s)
- Nathan J. Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Ian A. Buchanan
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Scott L. Zuckermann
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Matthew Geiselmann
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY
| | - Paul J. Park
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Eric Leung
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Avery L. Buchholz
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA
| | - Asham Khan
- Department of Neurosurgery, State University of New York, Buffalo, NY
| | - Jeffrey Mullin
- Department of Neurosurgery, State University of New York, Buffalo, NY
| | - John Pollina
- Department of Neurosurgery, State University of New York, Buffalo, NY
| | - Ehsan Jazini
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA
| | - Colin Haines
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA
| | | | | | - Joseph M. Lombardi
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
| | - Ronald A. Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY
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23
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Shafi KA, Pompeu YA, Vaishnav AS, Mai E, Sivaganesan A, Shahi P, Qureshi SA. Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery? Neurosurg Focus 2022; 52:E4. [DOI: 10.3171/2021.10.focus21526] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The accuracy of percutaneous pedicle screw placement has increased with the advent of robotic and surgical navigation technologies. However, the effect of robotic intraoperative screw size and trajectory templating remains unclear. The purpose of this study was to compare pedicle screw sizes and accuracy of placement using robotic navigation (RN) versus skin-based intraoperative navigation (ION) alone in minimally invasive lumbar fusion procedures.
METHODS
A retrospective cohort study was conducted using a single-institution registry of spine procedures performed over a 4-year period. Patients who underwent 1- or 2-level primary or revision minimally invasive surgery (MIS)–transforaminal lumbar interbody fusion (TLIF) with pedicle screw placement, via either robotic assistance or surgical navigation alone, were included. Demographic, surgical, and radiographic data were collected. Pedicle screw type, quantity, length, diameter, and the presence of endplate breach or facet joint violation were assessed. Statistical analysis using the Student t-test and chi-square test was performed to evaluate the differences in pedicle screw sizes and the accuracy of placement between both groups.
RESULTS
Overall, 222 patients were included, of whom 92 underwent RN and 130 underwent ION MIS-TLIF. A total of 403 and 534 pedicle screws were placed with RN and ION, respectively. The mean screw diameters were 7.25 ± 0.81 mm and 6.72 ± 0.49 mm (p < 0.001) for the RN and ION groups, respectively. The mean screw length was 48.4 ± 4.48 mm in the RN group and 45.6 ± 3.46 mm in the ION group (p < 0.001). The rates of “ideal” pedicle screws in the RN and ION groups were comparable at 88.5% and 88.4% (p = 0.969), respectively. The overall screw placement was also similar. The RN cohort had 63.7% screws rated as good and 31.4% as acceptable, while 66.1% of ION-placed screws had good placement and 28.7% had acceptable placement (p = 0.661 and p = 0.595, respectively). There was a significant reduction in high-grade breaches in the RN group (0%, n = 0) compared with the ION group (1.2%, n = 17, p = 0.05).
CONCLUSIONS
The results of this study suggest that robotic assistance allows for placement of screws with greater screw diameter and length compared with surgical navigation alone, although with similarly high accuracy. These findings have implied that robotic platforms may allow for safe placement of the “optimal screw,” maximizing construct stability and, thus, the ability to obtain a successful fusion.
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Affiliation(s)
| | | | | | - Eric Mai
- Hospital for Special Surgery, New York, New York
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24
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Soliman MA, Khan A, O'Connor TE, Foley K, Pollina J. Accuracy and Efficiency of Fusion Robotics™ Versus Mazor-X™ in Single-Level Lumbar Pedicle Screw Placement. Cureus 2021; 13:e15939. [PMID: 34211815 PMCID: PMC8236238 DOI: 10.7759/cureus.15939] [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] [Indexed: 11/09/2022] Open
Abstract
Introduction There has been a surge in robot utilization in spine surgery over the past five years with the rapid development of new spine robotic platforms. This study aimed to compare a new robotic spine platform from Fusion RoboticsTM (Fusion Robotics, Helena, MT) with the widely used Mazor-XTM Stealth Edition robotic platform (Medtronic, Dublin, Ireland) in terms of workflow and lumbar pedicle screw placement accuracy. Methods A cadaver lab was conducted, which included four procedures with single-level lumbar pedicle screw placement using the Fusion RoboticsTM system. These four procedures were compared to four propensity-score matched cases with single-level lumbar pedicle screw placement using the Mazor-XTM Stealth Edition. A single surgeon performed all surgeries. The cases were matched in terms of demographics (age, sex, race, BMI) and comorbidities (Charlson Comorbidity Index score). The primary outcome measure was the operative workflow efficiency (duration as measured with a stopwatch by an independent observer). The secondary outcome measures were pedicle screw accuracy and accuracy to plan. Results After propensity-score matching, there were four cases in each group with no significant between-group differences in terms of sex, race, BMI, or surgical levels; however, there were significant differences in terms of age (p=0.01) and comorbidities (p<0.001). The workflow efficiency measurement showed that the Fusion RoboticsTM platform had a significantly shorter duration in terms of the system set-up time, planning to in-position time, and total procedure time (p<0.05). However, there was no significant difference between the robotic platforms in terms of creating a sterile barrier, scanning and importing images, creating a plan, screw placement, screw accuracy, and screw accuracy to plan. Conclusion Based on our findings, the Fusion RoboticsTM platform had a significantly shorter procedure workflow duration while maintaining the same accuracy as the most commonly used robotic platform (Mazor-XTM). This is the first study to directly compare different spine surgery robotic systems.
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Affiliation(s)
- Mohamed A Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA.,Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, EGY
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA
| | - Timothy E O'Connor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA
| | - Kevin Foley
- Department of Neurosurgery, Semmes-Murphey Clinic & University of Tennessee Health Science Center, Memphis, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA
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25
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Piche JD, Muscatelli SR, Waheed MAA, Patel RD, Aleem IS. Robotic navigation system utilization for percutaneous sacroiliac screw placement: surgical setup and technique. JOURNAL OF SPINE SURGERY 2021; 7:197-203. [PMID: 34296032 DOI: 10.21037/jss-20-681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/22/2021] [Indexed: 01/26/2023]
Abstract
Sacroiliac joint (SIJ) pathology is a common cause of significant pain and disability, and operative treatment consisting of SIJ fusion can be performed in cases where non-operative measures fail to provide sustained relief. Through the years, SIJ fusion has evolved from an open invasive procedure, to more recently, being performed through minimally invasive techniques. Intraoperative navigation systems and robotic guidance are becoming popularized for SIJ fusion, as well as other routine and complex spinal cases. The utility of navigation and robotics is the enhanced ability of the surgeon to place instrumentation more accurately, with less dissection, blood less, and overall operative time. We present a technique guide for robotic instrumented SIJ fusion with intraoperative navigation that we have put into practice at our institution and found to be very beneficial to patients for the above reasons. We describe the setup and utilization of these technologies intraoperatively, and provide specific case examples to highlight our technique. The described methods have been found to be effective and reproducible, allowing for minimally invasive SIJ screw placement with high accuracy and safety. We emphasize that utilizing intraoperative navigation and robotics is not meant to substitute for surgeon knowledge of case steps or anatomy, but rather to enhance safety and efficacy. To our knowledge, robotic SIJ fusion has not been previously described in the literature.
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Affiliation(s)
- Joshua David Piche
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Rakesh D Patel
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ilyas S Aleem
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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26
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Shelke Y, Chakraborty C. Augmented Reality and Virtual Reality Transforming Spinal Imaging Landscape: A Feasibility Study. IEEE COMPUTER GRAPHICS AND APPLICATIONS 2021; 41:124-138. [PMID: 32746083 DOI: 10.1109/mcg.2020.3000359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article discusses a systematic review of the state-of-the-art on augmented reality (AR) and virtual reality (VR) in spinal navigation, where early clinical validations have shown promising outlook on accuracy and scalability parameters. The objective of this research is to evaluate clinical relevance for AR-VR enabled spinal surgical technologies and develop an economic feasibility model for stakeholders, such as patients, hospitals, and research organizations with technology adoption. From the influencing parameters, we identified the research gaps that can be explored going forward and a list of high priority research challenges that could provide an attractive research and development investment case for industry players.
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27
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Letter to the Editor: Spinal Navigation is Not the Same as Robotic Assistance in Surgery. Spine (Phila Pa 1976) 2021; 46:E463-E464. [PMID: 33692325 DOI: 10.1097/brs.0000000000003952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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28
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Mao JZ, Khan A, Soliman MAR, Levy BR, McGuire MJ, Starling RV, Hess RM, Agyei JO, Meyers JE, Mullin JP, Pollina J. Use of the Scan-and-Plan Workflow in Next-Generation Robot-Assisted Pedicle Screw Insertion: Retrospective Cohort Study and Literature Review. World Neurosurg 2021; 151:e10-e18. [PMID: 33684584 DOI: 10.1016/j.wneu.2021.02.119] [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] [Received: 01/17/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report our experience using the scan-and-plan workflow and review current literature on surgical efficiency, safety, and accuracy of next-generation robot-assisted (RA) spine surgery. METHODS The records of patients who underwent RA pedicle screw fixation were reviewed. The accuracy of pedicle screw placement was determined based on the Ravi classification system. To evaluate workflow efficiency, 3 demographically matched cohorts were created to analyze differences in time per screw placement (defined as operating room [OR] time divided by number of screws placed). Group A had <4 screws placed, Group B had 4 screws placed, and Group C had >4 screws placed. Intraoperative errors and postoperative complications were collected to elucidate safety. RESULTS Eighty-four RA cases (306 pedicle screws) were included for analysis. The mean number of screws placed was 2.1 ± 0.3 in Group A and 6.4 ± 1.2 in Group C; 4 screws were placed in Group B patients. The accuracy rate (Ravi grade I) was 98.4%. Screw placement time was significantly longer in Group A (101 ± 37.7 minutes) than Group B (50.5 ± 25.4 minutes) or C (43.6 ± 14.7 minutes). There were no intraoperative complications, robot failures, or in-hospital complications requiring a return to the OR. CONCLUSIONS The scan-and-plan workflow allowed for a high degree of accuracy. It was a safe method that provided a smooth and efficient OR workflow without registration errors or robotic failures. After the placement of 4 pedicle screws, the per-screw time remained constant. Further studies regarding efficiency and utility in multilevel procedures are necessary.
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Affiliation(s)
- Jennifer Z Mao
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt; Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Bennett R Levy
- George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Matthew J McGuire
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA
| | - Robert V Starling
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Justice O Agyei
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Joshua E Meyers
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
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