Accuracy of Pedicle Screw Placement and Four Other Clinical Outcomes of Robotic Guidance Technique versus Computer-Assisted Navigation in Thoracolumbar Surgery: A Meta-Analysis

2020 ◽  
Author(s):  
Lu-Ping Zhou ◽  
Ren-Jie Zhang ◽  
Yi-Wei Sun ◽  
Lai Zhang ◽  
Cai-Liang Shen
Keyword(s):  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Screw Placement ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
Assisted Navigation ◽  
Guidance Technique

The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation

2021 ◽  
Vol 34 (1) ◽  
pp. 127-134
Author(s):  
Andrew M. Gardeck ◽  
Xuan Pu ◽  
Qiuyu Yang ◽  
David W. Polly ◽  
Kristen E. Jones
Keyword(s):  
Pedicle Screw ◽  
Orthopedic Surgery ◽  
Simulation Training ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
Assisted Navigation ◽  
Significant Difference ◽  
Standardized Curriculum

OBJECTIVEResidency work-hour restrictions necessitate efficient, reproducible training. Simulation training for spinal instrumentation placement shows significant benefit to learners’ subjective and objective proficiency. Cadaveric laboratories are most effective but have high cost and low availability. The authors’ goal was to create a low-cost, efficient, reproducible spinal instrumentation placement simulation curriculum for neurosurgery and orthopedic surgery residents using synthetic models and 3D computer-assisted navigation, assessing subjective and objective proficiency with placement of thoracolumbar pedicle screws.METHODSFifteen neurosurgery and orthopedic surgery residents participated in a standardized curriculum with lecture followed by two separate sessions of thoracolumbar pedicle screw placement in a synthetic spine model utilizing 3D computer-assisted navigation. Data were collected on premodule experience, time and accuracy of screw placement, and both subjective and objective ratings of proficiency.RESULTSFifteen of 15 residents demonstrated improvement in subjective (Physician Performance Diagnostic Inventory Scale [PPDIS]) and 14 in objective (Objective Structured Assessment of Technical Skills [OSATS]) measures of proficiency in navigated screw placement with utilization of this curriculum (p < 0.001 for both), regardless of the number of cases of previous experience using thoracolumbar spinal instrumentation. Fourteen of 15 residents demonstrated decreased time per screw placement from session 1 to session 2 (p = 0.006). There was no significant difference in pedicle screw accuracy between session 1 and session 2.CONCLUSIONSA standardized curriculum using synthetic simulation training for navigated thoracolumbar pedicle screw placement results in significantly improved resident subjective and objective proficiency. Development of a nationwide competency curriculum using simulation training for spinal instrumentation placement should be considered for safe, efficient resident training.

Percutaneous pedicle screw placement with computer-navigated mapping in place of Kirschner wires

2013 ◽  
Vol 19 (5) ◽  
pp. 608-613 ◽  
Author(s):  
Thomas J. Gianaris ◽  
Gregory M. Helbig ◽  
Eric M. Horn
Keyword(s):  
Pedicle Screw ◽  
Navigation System ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Computer Assisted ◽  
Anatomical Landmarks ◽  
Pedicle Screw Placement ◽  
Assisted Navigation ◽  
Percutaneous Pedicle Screw ◽  
K Wires

Object Percutaneous pedicle screw insertion techniques are commonly used to treat a variety of spinal disorders. Typically, Kirschner (K)-wires are used to guide the insertion of taps and screws during placement since the normal anatomical landmarks are not visualized. The use of K-wires adds risks, such as vascular and nerve injuries as well as increased radiation exposure given the use of fluoroscopy. The authors describe a series of patients who had percutaneous pedicle screws placed using a new computer-assisted navigation technique without the need for K-wires. Methods Minimally invasive percutaneous pedicle screw placement in the thoracic and lumbar spine was performed in a consecutive series of 15 patients for a variety of spinal pathologies. Intraoperative 3D CT images were obtained and used with a computer-assisted navigation system to insert an awl-tap into each pedicle. The tap location in the pedicle was marked with the navigation software, and the awl-tap was then removed. The navigation system was used to identify each landmark to insert the pedicle screw. Connecting rods were then inserted percutaneously under fluoroscopic guidance. Postoperative CT scans were obtained in each patient to evaluate screw placement. Results On postprocedure scanning, only 1 screw had a minor lateral and superior breach that was asymptomatic. To date, there have been no hardware failures. Conclusions Percutaneous pedicle screws can be placed effectively and safely without the use of K-wires.

scholarly journals Overview of Robotic Technology in Spine Surgery

2021 ◽  
pp. 155633162110266
Author(s):  
Ram K. Alluri ◽  
Fedan Avrumova ◽  
Ahilan Sivaganesan ◽  
Avani S. Vaishnav ◽  
Darren R. Lebl ◽  
...  
Keyword(s):  
Economic Impact ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Screw Placement ◽  
Complication Rates ◽  
Robotic Technology ◽  
Pedicle Screw Placement ◽  
The Past ◽  
Compare And Contrast

As robotics in spine surgery has progressed over the past 2 decades, studies have shown mixed results on its clinical outcomes and economic impact. In this review, we highlight the evolution of robotic technology over the past 30 years, discussing early limitations and failures. We provide an overview of the history and evolution of currently available spinal robotic platforms and compare and contrast the available features of each. We conclude by summarizing the literature on robotic instrumentation accuracy in pedicle screw placement and clinical outcomes such as complication rates and briefly discuss the future of robotic spine surgery.

Variability Analysis of Manual and Computer-Assisted Preoperative Thoracic Pedicle Screw Placement Planning

Spine ◽  
2018 ◽  
Vol 43 (21) ◽  
pp. 1487-1495 ◽  
Author(s):  
Dejan Knez ◽  
Janez Mohar ◽  
Robert J. Cirman ◽  
Boštjan Likar ◽  
Franjo Pernuš ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
Variability Analysis ◽  
Thoracic Pedicle Screw

scholarly journals Does the application of Robotics improve outcomes of pedicle screw insertion in spine surgery compared to conventional fluoroscopy guidance? A protocol for Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Vishal Kumar ◽  
Vishnu Baburaj ◽  
Prasoon Kumar ◽  
Sarvdeep Singh Dhatt
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Meta Analysis ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Fluoroscopy Guidance

AbstractBackgroundPedicle screw insertion is routinely carried out in spine surgery that has traditionally been performed under fluoroscopy guidance. Robotic guidance has recently gained popularity in order to improve the accuracy of screw placement. However, it is unclear whether the use of robotics alters the accuracy of screw placement or clinical outcomes.ObjectivesThis systematic review aims to compare the results of pedicle screws inserted under fluoroscopy guidance, with those inserted under robotic guidance, in terms of both short-term radiographic outcomes, as well as long-term clinical outcomes.MethodsThis systematic review will be conducted according to the PRISMA guidelines. A literature search will be conducted on the electronic databases of PubMed, Embase, Scopus, and Ovid with a pre-determined search strategy. A manual bibliography search of included studies will also be done. Original articles in English that directly compare pedicle screw insertion under robotic guidance to those inserted under fluoroscopy guidance will be included. Data on outcomes will be extracted from included studies and analysis carried out with the help of appropriate software.

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