In Vitro Analysis of Accuracy, Dosage and Surgical Time Required for Pedicle Screw Placement Using Conventional Percutaneous Screw and Robotic-Assisted Screw Techniques

OBJECTIVE The application of robots in the field of pedicle screw placement has achieved great success. However, decompressive laminectomy, a step that is just as critical as pedicle screw placement, does not have a mature robot-assisted system. To address this lack, the authors designed a collaborative spine robot system to assist with laminectomy. In this study, they aimed to investigate the reliability of this novel collaborative spinal robot system and compare it with manual laminectomy (ML). METHODS Thirty in vitro porcine lumbar vertebral specimens were obtained as experimental bone specimens. Robot-assisted laminectomy (RAL) was performed on the left side of the lamina (n = 30) and ML was performed on the right side (n = 30). The time required for laminectomy on one side, whether the lamina was penetrated, and the remaining thickness of the lamina were compared between the two groups. RESULTS The time required for laminectomy on one side was longer in the RAL group than in the ML group (median 326 seconds [IQR 133 seconds] vs 108.5 seconds [IQR 43 seconds], p < 0.001). In the RAL group, complete lamina penetration occurred twice (6.7%), while in the ML group, it occurred 9 times (30%); the difference was statistically significant (p = 0.045). There was no statistically significant difference in the remaining lamina thickness between the two groups (median 1.035 mm [IQR 0.419 mm] vs 1.084 mm [IQR 0.383 mm], p = 0.842). CONCLUSIONS The results of this study confirm the safety of this novel spinal robot system for laminectomy. However, its efficiency requires further improvement.

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A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement

Journal of Visualized Experiments ◽

10.3791/60924 ◽

2020 ◽

Author(s):

Hsuan-Yu Chen ◽

Xiu-Yun Xiao ◽

Chih-Wei Chen ◽

Hao-Kai Chou ◽

Chen-Yu Sung ◽

...

Keyword(s):

Pedicle Screw ◽

Navigation System ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Robotic Assisted ◽

Assisted Navigation

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Application of a novel customized guide template in percutaneous pedicle screw placement: an in vitro study

10.29007/qzxg ◽

2018 ◽

Author(s):

Su-Hua Wu ◽

Guo Zheng ◽

Jian-Hua Chen ◽

Sheng-Hai Wang

Keyword(s):

Pedicle Screw ◽

Average Distance ◽

Pedicle Screws ◽

Screw Placement ◽

Patient Specific ◽

Pedicle Screw Placement ◽

Intraoperative Radiation ◽

Spine Stabilization ◽

Percutaneous Pedicle Screw

In open surgery for spine stabilization, the pedicle screws are often placed using patient-specific guide templates since they can improve the screw placement accuracy and simplify surgery. However, the conventional fit-and-lock template requires full exposure of the bony structures and is therefore not suitable for minimally invasive procedures. In this study, we constructed a novel guide template for percutaneous pedicle screw placement. Its feasibility and the accuracy of template-assisted pedicle screw placement were assessed using an excised calf spine model. As a result, all inserted guide wires and 27 of 30 simulated screws (90%) were completely in the pedicle. The remaining screws (10%) penetrated by less than 2 mm. The average distance and angular deviations of the guide wires were 1.46±0.60 mm and 1.10±0.84°. Our study demonstrate that this novel guide template is technically feasible and enhances the accuracy of percutaneous pedicle screw placement. Moreover, it may simplify the surgery and minimize intraoperative radiation. Further research on its clinical applications is warranted.

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The Efficacy of Reciproc Blue® For Canal Cleanliness Following the Retreatment of Maxillary First Molar: In Vitro Analysis

Malaysian Journal of Science Health & Technology ◽

10.33102/mjosht.v7i1.142 ◽

2021 ◽

Vol 7 (1) ◽

pp. 22-27

Author(s):

Mohd Nazrin Isa ◽

Aws Hashim Ali Al-Kadhim ◽

Azlan Jaafar

Keyword(s):

Filling Material ◽

Volume Percentage ◽

Gutta Percha ◽

Maxillary Molars ◽

Significant Difference ◽

Time Required ◽

Vitro Analysis ◽

Cleaning And Disinfection ◽

In Vitro Analysis

Nonsurgical retreatment involves removing mechanical barriers such as gutta-percha to achieve proper cleaning and disinfection. The complexity of the anatomy of molar tooth gives challenge in retreatment procedure. Thus, this study evaluates the amount of residual gutta-percha after retreatment with rotary files (Reciproc Blue®) from each maxillary first molar canal using cone-beam computed tomography (CBCT) and the time required to accomplish it. Nine freshly extracted maxillary molars were instrumented and obturated. Preoperative CBCT was taken, and retreatment was done using Reciproc Blue®. CBCT was taken post retreatment, and the residual volume percentage of gutta-percha from each canal was calculated. The total retreatment time was recorded, and the data were statistically analyzed. The result shows no statistically significant difference in the amount of residual filling material in mesiobuccal, distobuccal, and palatal canal for maxillary first molar and total time used for retreatment with Reciproc Blue® system.

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Robotic-Assisted Pedicle Screw Placement During Spine Surgery

JBJS Essential Surgical Techniques ◽

10.2106/jbjs.st.19.00020 ◽

2020 ◽

Vol 10 (2) ◽

pp. e0020-e0020

Author(s):

Isador H. Lieberman ◽

Stanley Kisinde ◽

Shea Hesselbacher

Keyword(s):

Pedicle Screw ◽

Spine Surgery ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Robotic Assisted

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Comparison of intraoperative O-arm- and conventional fluoroscopy (C-arm)-assisted insertion of pedicle screws in the treatment of fracture of thoracic vertebrae

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684090 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668409 ◽

Cited By ~ 2

Author(s):

Hao Liu ◽

Yimeng Wang ◽

Bin Pi ◽

Zhonglai Qian ◽

Xiaoyu Zhu ◽

...

Keyword(s):

Pedicle Screw ◽

Pedicle Screws ◽

Screw Placement ◽

Thoracic Vertebrae ◽

Pedicle Screw Placement ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Computed Tomography Images ◽

Hospitalization Time ◽

Time Required

Purpose: To introduce the intraoperative O-arm-assisted pedicle screw insertion without any navigation system in the treatment of thoracic vertebrae fracture and compare it to conventional fluoroscopy (C-arm)-assisted pedicle screw insertion technique. Methods: About 156 pedicle screws were inserted in 23 patients (C-arm group), and 208 pedicle screws were inserted in 30 patients (O-arm group). The postoperative computed tomography images were analyzed for pedicle violation based on Gertzbein classification. The total surgery time, the average time required for inserting a screw, the mean action times of adjusting guide probe and pedicle screw, and the hospitalization time were compared in both groups, respectively. The American Spinal Injury Association (ASIA) was used for evaluating the health outcomes pre- and postoperatively. Results: There are the higher accuracy rate of satisfactory pedicle screw placement (grades 0 and 1) and the less incidence of medial perforation in the O-arm group compared to the C-arm group ( p < 0.05). The average time required for inserting a screw, the action times of adjusting the guide probe and pedicle screw, and the hospitalization time in the O-arm group are less than the respective ones in the C-arm group ( p < 0.05). There was no significant difference for the total surgery time between both groups. No further damage of the nerve function postoperatively is found according to the ASIA grade. Conclusion: The O-arm-assisted pedicle screw insertion without navigation we described provides higher accuracy of pedicle screw placement and better clinical efficacy compared to conventional fluoroscopy (C-arm) technique.

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Robotic-assisted navigated minimally invasive pedicle screw placement in the first 100 cases at a single institution

Journal of Robotic Surgery ◽

10.1007/s11701-019-00959-6 ◽

2019 ◽

Vol 14 (1) ◽

pp. 199-203 ◽

Cited By ~ 6

Author(s):

Kade T. Huntsman ◽

Leigh A. Ahrendtsen ◽

Jessica R. Riggleman ◽

Charles G. Ledonio

Keyword(s):

Minimally Invasive ◽

Pedicle Screw ◽

Screw Placement ◽

Single Institution ◽

Pedicle Screw Placement ◽

Robotic Assisted

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Less Invasive Pediatric Spinal Deformity Surgery: The Case for Robotic-Assisted Placement of Pedicle Screws

HSS Journal ® ◽

10.1177/15563316211027828 ◽

2021 ◽

pp. 155633162110278

Author(s):

Kyle W. Morse ◽

Hila Otremski ◽

Kira Page ◽

Roger F. Widmann

Keyword(s):

Pedicle Screw ◽

Current Literature ◽

Spinal Deformity ◽

Spinal Surgery ◽

Pedicle Screws ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Robotic Assisted ◽

Less Invasive ◽

Spinal Deformity Surgery

Introduction: Pediatric spinal deformity involves a complex 3-dimensional (3D) deformity that increases the risk of pedicle screw placement due to the close proximity of neurovascular structures. To increase screw accuracy, improve patient safety, and minimize surgical complications, the placement of pedicle screws is evolving from freehand techniques to computer-assisted navigation and to the introduction of robotic-assisted placement. Purpose: The aim of this review was to review the current literature on the use of robotic navigation in pediatric spinal deformity surgery to provide both an error analysis of these techniques and to provide recommendations to ensure its safe application. Methods: A narrative review was conducted in April 2021 using the MEDLINE (PubMed) database. Studies were included if they were peer-reviewed retrospective or prospective studies, included pediatric patients, included a primary diagnosis of pediatric spine deformity, utilized robotic-assisted spinal surgery techniques, and reported thoracic or lumbar pedicle screw breach rates or pedicle screw malpositioning. Results: In the few studies published on the use of robotic techniques in pediatric spinal deformity surgery, several found associations between the technology and increased rates of screw placement accuracy, reduced rates of breach, and minimal complications. All were retrospective studies. Conclusions: Current literature is of a low level of evidence; nonetheless, the findings suggest the accuracy and safety of robotic-assisted spinal surgery in pediatric pedicle screw placement. The introduction of robotics may drive further advances in less invasive pediatric spinal deformity surgery. Further study is warranted.

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Comparative Analysis of Pedicle Screw Placement in Children with Congenital Scoliosis: Freehand Technique (in vivo) and Guide Templates (in vitro)

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2018-24-4-53-63 ◽

2018 ◽

Vol 24 (4) ◽

pp. 53-63 ◽

Cited By ~ 2

Author(s):

D. N. Kokushin ◽

S. V. Vissarionov ◽

A. G. Baindurashvili ◽

A. V. Ovechkina ◽

M. S. Poznovich

Keyword(s):

Lumbar Spine ◽

Pedicle Screw ◽

Pedicle Screws ◽

Congenital Scoliosis ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Placement Accuracy ◽

Thoracolumbar Transition

Objective.To evaluate accuracy between pedicle screw placement in vertebral bodies achieved in vivo with freehand techniques versus their placement in vertebrae plastic models achieved in vitro with the use of guide templates, in toddlers and preschool children with congenital kyphoscoliosis of the thoracolumbar transition and lumbar spine amid the vertebral malformation.Material and Methods. The research is based on a retrospective analysis of the results of treatment of 10 patients with congenital kyphoscoliosis of the thoracolumbar transition and lumbar spine amid the vertebral malformation. Age – from 2 years 2 months to 6 years 8 months old (mean 3 years 8 months old), gender – 6 boys, 4 girls. Based on the postoperative multi-slice spiral computed tomography (MSCT) of the spine, the pedicle screws placement accuracy of the correcting multi-support metalwork was evaluated. These patients constituted the 1st research group (in vivo group). The 2nd research group (in vitro group) was formed from 27 vertebrae plastic models with pedicle screws inserted in them with the use of guide templates. The placement accuracy of the installed pedicle support elements was assessed based on the S.D. Gertzbein et al. scale (1990).Results. In the 1st group, there were 52 pedicle screws placed. The screw placement accuracy according to the rate of misplacement, as follows: 53.8% in Grade 0, 25% in Grade I, 11.6% in Grade II, 9.6% in Grade III. The number of screws with the rate of misplacement in Grade 0 + Grade I was 41 (78.8%). In the 2nd group, there were 54 screws placed and slightly larger than the 1st group. The screw placement accuracy according to the rate of misplacement was 94.4% in Grade 0, 1.9% in Grade I, 3.7% in Grade II, respectively. The number of screws with the rate of misplacement in Grade 0 + Grade I was 52 (96.3%).Conclusions.Comparative analysis showed that the number of pedicle screws successfully placed in vertebrae plastic models in children with congenital deformities of the thoracolumbar transition and lumbar spine achieved with the use of guide templates was significantly higher than the number of screws successfully placed with freehand techniques (96.3% versus 80.8%, p = 0.011). The results obtained with method of navigation templates in vitro showed high precision and accuracy of pedicle screw placement which gives the prospect for using this type of navigation in clinical practice in toddlers with congenital scoliosis.

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The Accuracy and Effectiveness of Automatic Pedicle Screw Trajectory Planning Based on CT Values: An in Vitro Osteoporosis Model Study.

10.21203/rs.3.rs-1048750/v1 ◽

2021 ◽

Author(s):

JiaBin Liu ◽

Rui Zuo ◽

WenJie Zheng ◽

ChangQing Li ◽

Chao Zhang ◽

...

Keyword(s):

Pedicle Screw ◽

Screw Placement ◽

Control Group ◽

Mineral Density ◽

Pedicle Screw Placement ◽

Ct Value ◽

Pull Out ◽

Vertebral Bodies ◽

Automatic Planning

Abstract BackgroundPedicle screw placement in patients with osteoporosis is a serious clinical challenge. The bone mineral density (BMD) of the screw trajectory has been positively correlated with the screw pull-out force, while the CT value has been linearly correlated with the BMD. The purpose of this study was to establish an in vitro osteoporosis model and verify the accuracy and effectiveness of automated pedicle screw planning software based on CT values in this model.MethodsTen vertebrae (L1-L5) of normal adult pigs were randomly divided into a decalcification group and a control group. In the decalcification group, the vertebral bodies were decalcified with Ethylenediaminetetraacetic acid (EDTA) to construct an in vitro osteoporosis model. In the decalcification group, automatic planning (AP) and conventional manual planning (MP) were used to plan the pedicle screw trajectory on the left and right sides of the pedicle, respectively, and MP was used on both sides of the control group. CT values of trajectories obtained by the two methods were measured and compared. Then, 3D-printed guide plates were designed to assist pedicle screw placement. A biomechanical instrument was used to measure the pull-out force of the trajectory obtained by the two methods.ResultsAfter decalcification, the T' value of the vertebral body decreased from -0.03 ± 1.03 to -3.03 ± 0.29 (P <0.05). In the decalcification group, the MP trajectory CT value was 2167.28 ± 65.62 Hu, the AP trajectory CT value was 2723.96 ± 165.83 Hu, and the MP trajectory CT value in the control group was 2242.94 ± 25.80 Hu (P<0.05). In the decalcified vertebrae, the screw pull-out force of the MP group was 48.6% lower than that of the control group (P <0.05). The pull-out force of the AP trajectory was 44.7% higher than that of the MP trajectory (P <0.05) and reached 97.4% of the MP trajectory in the control group (P >0.05).ConclusionAutomatic planning of the pedicle screw trajectory based on the CT value can obtain a higher screw pull-out force, which is a valuable new method of pedicle screw placement in osteoporotic vertebral bodies.

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