Navigated minimally invasive facet fusion during percutaneous lumbar pedicle screw insertion: Technical note

OBJECTIVE Pedicle screw insertion for stabilization after lumbar fusion surgery is commonly performed by spine surgeons. With the advent of navigation technology, the accuracy of pedicle screw insertion has increased. Robotic guidance has revolutionized the placement of pedicle screws with 2 distinct radiographic registration methods, the scan-and-plan method and CT-to-fluoroscopy method. In this study, the authors aimed to compare the accuracy and safety of these methods. METHODS A retrospective chart review was conducted at 2 centers to obtain operative data for consecutive patients who underwent robot-assisted lumbar pedicle screw placement. The newest robotic platform (Mazor X Robotic System) was used in all cases. One center used the scan-and-plan registration method, and the other used CT-to-fluoroscopy for registration. Screw accuracy was determined by applying the Gertzbein-Robbins scale. Fluoroscopic exposure times were collected from radiology reports. RESULTS Overall, 268 patients underwent pedicle screw insertion, 126 patients with scan-and-plan registration and 142 with CT-to-fluoroscopy registration. In the scan-and-plan cohort, 450 screws were inserted across 266 spinal levels (mean 1.7 ± 1.1 screws/level), with 446 (99.1%) screws classified as Gertzbein-Robbins grade A (within the pedicle) and 4 (0.9%) as grade B (< 2-mm deviation). In the CT-to-fluoroscopy cohort, 574 screws were inserted across 280 lumbar spinal levels (mean 2.05 ± 1.7 screws/ level), with 563 (98.1%) grade A screws and 11 (1.9%) grade B (p = 0.17). The scan-and-plan cohort had nonsignificantly less fluoroscopic exposure per screw than the CT-to-fluoroscopy cohort (12 ± 13 seconds vs 11.1 ± 7 seconds, p = 0.3). CONCLUSIONS Both scan-and-plan registration and CT-to-fluoroscopy registration methods were safe, accurate, and had similar fluoroscopy time exposure overall.

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Accuracy of augmented reality surgical navigation for minimally invasive pedicle screw insertion in the thoracic and lumbar spine with a new tracking device

The Spine Journal ◽

10.1016/j.spinee.2019.12.009 ◽

2020 ◽

Vol 20 (4) ◽

pp. 629-637 ◽

Cited By ~ 5

Author(s):

Simon Peh ◽

Anindita Chatterjea ◽

Julian Pfarr ◽

Jost Philipp Schäfer ◽

Matthias Weuster ◽

...

Keyword(s):

Lumbar Spine ◽

Augmented Reality ◽

Minimally Invasive ◽

Pedicle Screw ◽

Surgical Navigation ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Thoracic And Lumbar Spine ◽

Tracking Device

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The Barrow Biomimetic Spine: Face, Content, and Construct Validity of a 3D-Printed Spine Model for Freehand and Minimally Invasive Pedicle Screw Insertion

Global Spine Journal ◽

10.1177/2192568218824080 ◽

2019 ◽

Vol 9 (6) ◽

pp. 635-641 ◽

Cited By ~ 2

Author(s):

Michael A. Bohl ◽

Rohit Mauria ◽

James J. Zhou ◽

Michael A. Mooney ◽

Joseph D. DiDomenico ◽

...

Keyword(s):

Minimally Invasive ◽

Construct Validity ◽

Pedicle Screw ◽

Surgical Training ◽

Screw Insertion ◽

Training Models ◽

3 Dimensional ◽

Pedicle Screw Insertion ◽

The Face ◽

Spine Model

Study Design: Description and evaluation of a novel surgical training platform. Objectives: The purpose of this study was to investigate the face, content, and construct validity of 5 novel surgical training models that simulate freehand and percutaneous (minimally invasive surgery [MIS]) pedicle screw placement. Methods: Five spine models were developed by residents: 3 for freehand pedicle screw training (models A-C) and 2 for MIS pedicle screw training (models D and E). Attending spine surgeons evaluated each model and, using a 20-point Likert-type scale, answered survey questions on model face, content, and construct validity. Scores were statistically evaluated and compared using means, standard deviations, and analysis of variance between models and between surgeons. Results: Among the freehand models, model C demonstrated the highest overall validity, with mean face (15.67 ± 5.49), content (19.17 ± 0.59), and construct (18.83 ± 0.24) validity all measuring higher than the other freehand models. For the MIS models, model D had the highest validity scores (face, content, and construct validity of 11.67 ± 3.77, 18.17 ± 2.04, and 17.00 ± 3.46, respectively). The 3 freehand models differed significantly in content validity scores ( P = .002) as did the 2 MIS models ( P < .001). The testing surgeons’ overall validity scores were significantly different for models A ( P = .005) and E ( P < .001). Conclusions: A 3-dimensional-printed spine model with incorporated bone bleeding and silicone rubber soft tissue was scored as having very high content and construct validity for simulating freehand pedicle screw insertion. These data has informed the further development of several surgical training models that hold great potential as educational adjuncts in surgical training programs.

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