Robot-Assisted Versus Fluoroscopy-Guided Pedicle Screw Placement in Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Disease

2019 ◽  
Vol 125 ◽  
pp. e429-e434 ◽  
Author(s):  
Qi Zhang ◽  
Xiao-Guang Han ◽  
Yun-Feng Xu ◽  
Ya-Jun Liu ◽  
Bo Liu ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Degenerative Disease ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Lumbar Degenerative Disease

scholarly journals Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement Under Regional Anaesthesia: A Comparative Cohort Study

2021 ◽  
Author(s):  
Shangju Gao ◽  
Jingchao Wei ◽  
Wenyi Li ◽  
Long Zhang ◽  
Can Cao ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
General Anaesthesia ◽  
Pedicle Screw ◽  
Regional Anaesthesia ◽  
Interbody Fusion ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Percutaneous Pedicle Screw

Abstract Background: Robot-assisted pedicle screw placement is usually performed under general anaesthesia to keep the body still. The aim of this study was to compare the accuracy of the robot-assisted technique under regional anaesthesia with conventional fluoroscopy-guided percutaneous pedicle screw placement under general anaesthesia in minimally invasive lumbar fusion surgery.Methods: Patients who underwent robot-assisted percutaneous endoscopic lumbar interbody fusion (PELIF) or fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) from December 2017 to February 2020 in a single centre were included. Based on the method of percutaneous pedicle screw placement used, patients were divided into the robot-assisted under regional anaesthesia (group RE-RO) and fluoroscopy-guided under general anaesthesia (group GE-FLU) groups. The primary outcome measures were screw accuracy and the incidence of facet joint violation (FJV). Secondary outcome measures included X-ray exposure and intraoperative adverse events.Results: Eighteen patients were included in group RE-RO, and 23 patients were included in group GE-FLU. The percentages of clinically acceptable screws (Gertzbein and Robbins grades A and B) were 94.4% and 91.5%, respectively. There was no significant difference in the percentages of clinically acceptable screws (p=0.44) or overall Gertzbein and Robbins screw accuracy grades (p=0.35). Only the top screws were included in the analysis of FJVs. The percentages of FJV (Babu grades 1, 2 and 3) were 5.6% and 28.3%, respectively. This difference was statistically significant (p=0.01). Overall, the FJV grades in group RE-RO were significantly better than those in group GE-FLU (p=0.009). The mean fluoroscopy time for each screw in group RE-RO was significantly shorter than that in group GE-FLU (group RE-RO, 5.4±1.9 seconds, group GE-FLU, 6.8±2.0 seconds; P=0.03). The intraoperative adverse events included 1 case of registration failure and 1 case of guide-wire dislodgment in group RE-RO as well as 2 cases of screw misplacement in group GE-FLU. No complications related to anaesthesia were observed.Conclusion: Robot-assisted pedicle screw placement under regional anaesthesia can be performed effectively and safely. The accuracy is comparable to the conventional technique. Moreover, this technique has the advantage of fewer FJVs and a lower radiation time.

scholarly journals Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement under Regional Anesthesia: A Retrospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Shangju Gao ◽  
Jingchao Wei ◽  
Wenyi Li ◽  
Long Zhang ◽  
Can Cao ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Pedicle Screw ◽  
Regional Anesthesia ◽  
Interbody Fusion ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Percutaneous Pedicle Screw ◽  
Anesthesia Group

Background. Robot-assisted pedicle screw placement is usually performed under general anesthesia to keep the body still. The aim of this study was to compare the accuracy of the robot-assisted technique under regional anesthesia with that of conventional fluoroscopy-guided percutaneous pedicle screw placement under general anesthesia in minimally invasive lumbar fusion surgery. Methods. This study recruited patients who underwent robot-assisted percutaneous endoscopic lumbar interbody fusion (PELIF) or fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) between December 2017 and February 2020 at a single center. Based on the method of percutaneous pedicle screw placement used, patients were divided into the robot-assisted under regional anesthesia (group RE-RO) and fluoroscopy-guided under general anesthesia (group GE-FLU) groups. The primary outcome measures were screw accuracy and the incidence of facet joint violation (FJV). Secondary outcome measures included X-ray and visual analogue scale (VAS) scores which were used to evaluate the degree of the postoperative pain at 4 hours and on postoperative days 1, 2, and 3. Intraoperative adverse events were also recorded. Results. Eighteen patients were included in group RE-RO, and 23 patients were included in group GE-FLU. The percentages of clinically acceptable screws (Gertzbein and Robbins grades A and B) were 94.4% and 91.5%, respectively. There was no significant difference in the percentages of clinically acceptable screws ( p = 0.44 ) or overall Gertzbein and Robbins screw accuracy grades ( p = 0.35 ). Only the top screws were included in the analysis of FJVs. The percentages of FJV (Babu grades 1, 2, and 3) were 5.6% and 28.3%, respectively. This difference was statistically significant ( p = 0.01 ). Overall, the FJV grades in group RE-RO were significantly better than those in group GE-FLU ( p = 0.009 ). The mean fluoroscopy time for each screw in group RE-RO was significantly shorter than that in group GE-FLU (group RE-RO: 5.4 ± 1.9 seconds and group GE-FLU: 6.8 ± 2.0 seconds; p = 0.03 ). The postoperative pain between the RE-RO and GE-FLU groups was not statistically significant. The intraoperative adverse events included 1 case of registration failure and 1 case of guide-wire dislodgment in group RE-RO, as well as 2 cases of screw misplacement in group GE-FLU. No complications related to anesthesia were observed. Conclusion. Robot-assisted pedicle screw placement under regional anesthesia can be performed effectively and safely. The accuracy is comparable to the conventional technique. Moreover, this technique has the advantage of fewer FJVs and a lower radiation time.

Incidence of and risk factors for superior facet violation in minimally invasive versus open pedicle screw placement during transforaminal lumbar interbody fusion: a comparative analysis

2013 ◽  
Vol 18 (4) ◽  
pp. 356-361 ◽  
Author(s):  
Darryl Lau ◽  
Samuel W. Terman ◽  
Rakesh Patel ◽  
Frank La Marca ◽  
Paul Park
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Facet Joint ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw

Object A reported risk factor for adjacent-segment disease is injury to the superior facet joint from pedicle screw placement. Given that the facet joint is not typically visualized during percutaneous pedicle screw insertion, there is a concern for increased facet violation (FV) in minimally invasive fusion procedures. The purpose of this study was to analyze and compare the incidence of FV among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open transforaminal lumbar interbody fusion (TLIF). The impact of O-arm navigation compared with traditional fluoroscopy on FV in MITLIF is also assessed, as are risk factors for FV. Methods The authors identified a consecutive population of patients who underwent MITLIF with percutaneous pedicle screw placement, as well as a matched cohort of patients who underwent open TLIF. Postoperative CT imaging was assessed to determine intraarticular FV due to pedicle screw placement. Patients were stratified into minimally invasive and open TLIF groups. Within the MITLIF group, the authors performed a subanalysis of image guidance methods used in cases of FV. Two-tailed Student t-test, ANOVA, chi-square testing, and logistic regression were used for statistical analysis. Results A total of 282 patients were identified, with a total of 564 superior pedicle screw placements. The MITLIF group consisted of 142 patients with 284 screw insertions. The open TLIF group consisted of 140 patients with 280 screw insertions. Overall, 21 (7.4%) of 282 patients experienced FV. A total of 21 screws violated a facet joint for a screw-based FV rate of 3.7% (21 of 564 screws). There were no significant differences between the MITLIF and open TLIF groups in the percentage of patients with FV (6.3% vs 8.6%) and or the percentage of screws with FV (3.2% vs 4.3%) (p = 0.475 and p = 0.484, respectively). Further stratifying the MI group into O-arm navigation and fluoroscopic guidance subgroups, the patient-based rates of FV were 10.8% (4 of 37 patients) and 4.8% (5 of 105 patients), respectively, and the screw-based rates of FV were 5.4% (4 of 74 screws) and 2.4% (5 of 210 screws), respectively. There was no significant difference between the subgroups with respect to patient-based or screw-based FV rates (p = 0.375 and p = 0.442, respectively). The O-arm group had a significantly higher body mass index (BMI) (p = 0.021). BMI greater than 29.9 was independently associated with higher FV (OR 2.36, 95% CI 1.65–8.53, p = 0.039). Conclusions The findings suggest that minimally invasive pedicle screw placement is not associated with higher rates of FV. Overall violation rates were similar in MITLIF and open TLIF. Higher BMI, however, was a risk factor for increased FV. The use of O-arm fluoroscopy with computer-assisted guidance did not significantly decrease the rate of FV.

scholarly journals Navigated robot-guided pedicle screws placed successfully in single-position lateral lumbar interbody fusion

2019 ◽  
Vol 14 (4) ◽  
pp. 643-647 ◽  
Author(s):  
Kade T. Huntsman ◽  
Jessica R. Riggleman ◽  
Leigh A. Ahrendtsen ◽  
Charles G. Ledonio
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Lead Author ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Lateral Lumbar Interbody Fusion

Abstract Minimally invasive lateral interbody fusion has distinct advantages over traditional posterior approaches. When posterior stabilization is needed, percutaneous placement of pedicle screws from the lateral decubitus position may potentially increase safety and improve operative efficiency by precluding the need for repositioning. However, safe placement of pedicle screws in the lateral position remains technically challenging. This study describes the pedicle screw placement of single-position lateral lumbar interbody fusion (SP-LLIF) cases in which navigated robotic assistance was used. A single-surgeon, single-site, retrospective Institutional Review Board-exempt review of the first 55 SP-LLIF navigated robot-assisted spine surgery cases performed by the lead author was conducted. An orthopaedic surgeon evaluated screw placement using plain film radiographs. In addition, pedicle screw malposition, reposition, and return to operating room (OR) rates were collected. In the first 55 SP-LLIF cases, 342 pedicle screws were placed. The average patient age and body mass index were 67 years and 29.5 kg/m2, respectively. Of the 342 screws placed, 4% (14/342) were placed manually without the robot, due to surgeon discretion. Of the 328 screws placed with the robot, 2% (7/328) were repositioned based on the surgeon’s discretion, resulting in a 98% navigated robot-assisted pedicle screw placement success rate. In this cohort there were no revisions due to malpositioned screws. No complications due to screw placement were reported. This study demonstrates a high level (98%) of successful surgeon-assessed pedicle screw placement in minimally invasive navigated robot-assisted SP-LLIF, with no malpositions requiring a return to the OR.

Lumbar Interbody Fusion Using the Brantigan I/F Cage for Posterior Lumbar Interbody Fusion and the Variable Pedicle Screw Placement System

Spine ◽  
2000 ◽  
Vol 25 (11) ◽  
pp. 1437-1446 ◽  
Author(s):  
John W. Brantigan ◽  
Arthur D. Steffee ◽  
Mary L. Lewis ◽  
Linda M. Quinn ◽  
J. Maarten Persenaire
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement

scholarly journals Single Position Lateral Lumbar Fusion Utilizing Robot Guided Screw Placement

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
George V Huffmon
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Structural Integrity ◽  
Lumbar Fusion ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Lateral Position ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement

Abstract INTRODUCTION Lateral position interbody lumbar fusion surgery has become popular as an excellent modality for obtaining lumbar fusion and achieving sagital balance. Posterior instrumentation with pedicle screw fixation adds structural integrity to the construct. Maintaining the patient in the lateral position for pedicle screw placement decreases the time that the patient is under general anesthesia. Since August 2017 we have successfully performed 32 single position pedicle screw fixations utilizing robotic guidance. METHODS The lateral position was utilized for interbody fusion using a variety of techniques; oblique lumbar interbody fusion, extreme lateral lumbar interbody fusion, and lateral anterior lumbar interbody fusion. The Mazor X robot (Medtronic) was utilized for guidewire placement maintaining the patient in the lateral position. Pedicle screws of various manufacturers were placed over the guide wires and connecting rods were placed in the lateral position. RESULTS Since August 2017 we have successfully placed pedicle screws in 1 and 2 level single position lateral lumbar fusions in 32 of 39 cases attempted. There were no nerve root injuries nor any complications related to pedicle screw placement. CONCLUSION Single position lateral lumbar fusion cases utilizing robotic guidance for pedicle screw placement is a viable surgical procedure. Placement of the pedicle screws in the lateral position can reduce intraoperative anesthetic time by eliminating the placement of the patient into the prone position. Utilization of robotic guidance can decrease intraoperative fluoroscopy exposure.

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