Handmade Cement Spacer Technique for Pedicle Screw Placement in Revision Spinal Surgery

Abstract INTRODUCTION Robot-assisted surgery has emerged as an innovative and minimally-invasive technique, touted as superior to the traditional free-hand technique of pedicle screw fixation in spinal fusion surgery. Complications of misplaced pedicle screws include inadequate fixation and surgical failure requiring revision, neural injury, cerebrospinal fluid (CSF) leak, vascular injury, and facet joint trauma with sequela of adjacent segment disease. Literature reports an incidence of pedicle screw misplacement in up to 10% with free-hand technique. Robot-assisted surgery has reported superiority with increased accuracy of pedicle screw placement and reduced complication rates. This prospective multi-institutional single cohort analysis reports the outcomes in robot-assisted spinal fusion surgery in Melbourne, Australia over 4 yr. METHODS Data was prospectively collected from 2015 to 2019 from robot-assisted spinal surgeries performed by 2 surgeons across 2 institutions. Postoperative spinal computed tomography (CT) scan was compared to preoperative CT based planning to determine the accuracy of pedicle screw placement to 0.1 mm. Accurate pedicle screw placement was defined as within 2.0 mm from the target. Intraoperative radiation exposure time, operative time and length of hospital stay were also collected. RESULTS The total number of cases was 164 and the total number of screws placed was 744. Accurate pedicle screw placement was 98.65%. Average intraoperative radiation exposure time was 9.9 s. Average operative time for single-level surgery was 74 min. The average length of hospital stay was 2.4 d. CONCLUSION The authors conclude that robot-assisted pedicle screw placement is a safe and highly accurate adjunct to spinal surgery. While robot-assisted spinal surgery significantly improves patient outcomes with reduced patient morbidity and revision rates, it has limitations in primary capital expenditure, consumable costs and, in training and accreditation. It is the authors’ opinion that the robot-assisted spinal surgery technique requires nuanced patient selection and expertise in the traditional free-hand method is still essential in the event of technological failure.

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Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial

Journal of Neurosurgery Spine ◽

10.3171/2018.10.spine18487 ◽

2019 ◽

Vol 30 (5) ◽

pp. 615-622 ◽

Cited By ~ 24

Author(s):

Xiaoguang Han ◽

Wei Tian ◽

Yajun Liu ◽

Bo Liu ◽

Da He ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Radiation Exposure ◽

Pedicle Screw ◽

Spinal Surgery ◽

Facet Joint ◽

Postoperative Hospital Stay ◽

Screw Placement ◽

Pedicle Screw Placement ◽

The Mean

OBJECTIVEThe object of this study was to compare the safety and accuracy of pedicle screw placement using the TiRobot system versus conventional fluoroscopy in thoracolumbar spinal surgery.METHODSPatients with degenerative or traumatic thoracolumbar spinal disorders requiring spinal instrumentation were randomly assigned to either the TiRobot-assisted group (RG) or the freehand fluoroscopy-assisted group (FG) at a 1:1 ratio. The primary outcome measure was the accuracy of screw placement according to the Gertzbein-Robbins scale; grades A and B (pedicle breach < 2 mm) were considered clinically acceptable. In the RG, discrepancies between the planned and actual screw placements were measured by merging postoperative CT images with the trajectory planning images. Secondary outcome parameters included proximal facet joint violation, duration of surgery, intraoperative blood loss, conversion to freehand approach in the RG, postoperative hospital stay, and radiation exposure.RESULTSA total of 1116 pedicle screws were implanted in 234 patients (119 in the FG, and 115 in the RG). In the RG, 95.3% of the screws were perfectly positioned (grade A); the remaining screws were graded B (3.4%), C (0.9%), and D (0.4%). In the FG, 86.1% screws were perfectly positioned (grade A); the remaining screws were graded B (7.4%), C (4.6%), D (1.4%), and E (0.5%). The proportion of clinically acceptable screws was significantly greater in the RG than in the FG (p < 0.01). In the RG, the mean deviation was 1.5 ± 0.8 mm for each screw. The most common direction of screw deviation was lateral in the RG and medial in the FG. Two misplaced screws in the FG required revision surgery, whereas no revision was required in the RG. None of the screws in the RG violated the proximal facet joint, whereas 12 screws (2.1%) in the FG violated the proximal facet joint (p < 0.01). The RG had significantly less blood loss (186.0 ± 255.3 ml) than the FG (217.0 ± 174.3 ml; p < 0.05). There were no significant differences between the two groups in terms of surgical time and postoperative hospital stay. The mean cumulative radiation time was 81.5 ± 38.6 seconds in the RG and 71.5 ± 44.2 seconds in the FG (p = 0.07). Surgeon radiation exposure was significantly less in the RG (21.7 ± 11.5 μSv) than in the FG (70.5 ± 42.0 μSv; p < 0.01).CONCLUSIONSTiRobot-guided pedicle screw placement is safe and useful in thoracolumbar spinal surgery.Clinical trial registration no.: NCT02890043 (clinicaltrials.gov)

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Evaluation of K-wireless robotic and navigation assisted pedicle screw placement in adult degenerative spinal surgery: learning curve and technical notes

Journal of Spine Surgery ◽

10.21037/jss-20-687 ◽

2021 ◽

Vol 7 (2) ◽

pp. 141-154

Author(s):

Fedan Avrumova ◽

Kyle W. Morse ◽

Madison Heath ◽

Roger F. Widmann ◽

Darren R. Lebl

Keyword(s):

Learning Curve ◽

Pedicle Screw ◽

Spinal Surgery ◽

Screw Placement ◽

Pedicle Screw Placement

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Pedicle screw placement accuracy in thoracic and lumbar spinal surgery with a patient-matched targeting guide: a cadaveric study

European Spine Journal ◽

10.1007/s00586-015-4261-y ◽

2015 ◽

Vol 24 (S7) ◽

pp. 937-941 ◽

Cited By ~ 17

Author(s):

Claudio Lamartina ◽

Riccardo Cecchinato ◽

Zsolt Fekete ◽

Alberto Lipari ◽

Meinrad Fiechter ◽

...

Keyword(s):

Pedicle Screw ◽

Spinal Surgery ◽

Cadaveric Study ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Placement Accuracy ◽

Lumbar Spinal Surgery ◽

Lumbar Spinal

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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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A Case-Controlled Study Evaluating the Effect of Cone Beam CT (O-Arm) Imaging and Navigation on Pedicle Screw Placement in Adult Spinal Surgery

Global Spine Journal ◽

10.1055/s-0035-1554331 ◽

2015 ◽

Vol 5 (1_suppl) ◽

pp. s-0035-1554331-s-0035-1554331

Author(s):

Jason Strelzow ◽

Danny Mendelsohn ◽

Nicolas Dea ◽

Mélissa Nadeau ◽

Marcel Dvorak ◽

...

Keyword(s):

Pedicle Screw ◽

Spinal Surgery ◽

Cone Beam Ct ◽

Cone Beam ◽

Screw Placement ◽

Controlled Study ◽

Pedicle Screw Placement

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Free-Hand Pedicle Screw Placement During Revision Spinal Surgery

Spine ◽

10.1097/brs.0b013e31816f28a1 ◽

2008 ◽

Vol 33 (10) ◽

pp. 1141-1148 ◽

Cited By ~ 34

Author(s):

Young-Woo Kim ◽

Lawrence G. Lenke ◽

Yongjung J. Kim ◽

Keith H. Bridwell ◽

Youngbae B. Kim ◽

...

Keyword(s):

Pedicle Screw ◽

Spinal Surgery ◽

Screw Placement ◽

Pedicle Screw Placement

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Safety and Risk Factors of Tinavi Robot-assisted Percutaneous Pedicle Screw Placement in Spinal Surgery

10.21203/rs.3.rs-451919/v1 ◽

2021 ◽

Author(s):

Ren-Jie Zhang ◽

Lu-Ping Zhou ◽

Lai Zhang ◽

Hua-Qing Zhang ◽

Jian-Xiang Zhang ◽

...

Keyword(s):

Risk Factors ◽

Pedicle Screw ◽

Spinal Surgery ◽

Multivariate Analyses ◽

Univariate Analysis ◽

Pedicle Screws ◽

Screw Placement ◽

Insertion Point ◽

Pedicle Screw Placement ◽

Robot Assisted

Abstract Objective To determine the rates and risk factors of pedicle screw placement accuracy and the proximal facet joint violation (FJV) using TINAVI robot-assisted technique.Methods Patients with thoracolumbar fractures or degenerative diseases were retrospectively recruited from June 2018 and June 2020. The pedicle penetration and proximal FJV were compared in different instrumental levels to identify the safe and risk segments during insertion. Moreover, the factors were also assessed using univariate and multivariate analyses.Results A total of 72 patients with 332 pedicle screws were included in the current study. The optimal and clinically acceptable screw positions were 85.8% and 93.4%. Of the 332 screws concerning the intra-pedicular accuracy, 285 screws (85.8%) were evaluated as grade A according to the Gertzbein and Robbins scale, with the remaining 25 (7.6%), 10 (3.0%), 6 (1.8%), and 6 screws (1.8%) as grade B, C, D, and E. Moreover, in terms of the proximal FJV, 255 screws (76.8%) screws were assessed as grade 0 according to the Babu scale, with the remaining 34 (10.3%), 22 (6.6%), and 21 screws (6.3%) as grade 1, 2, and 3. Furthermore, the univariate analysis showed significantly higher rate of penetration for patients with age＜61 years old, sex of female, thoracolumbar insertion, shorter distance from skin to insertion point, and smaller facet angle. Meanwhile, the patients with the sex of female, BMI <25.9, grade I spondylolisthesis, lumbosacral insertion, longer distance from skin to insertion point, and larger facet angle had a significantly higher rate of proximal FJV. The outcomes of multivariate analyses showed that sex of male (adjusted OR 0.320, 95% CI 0.140–0.732; p =0.007), facet angle ≥45° (adjusted OR 0.266, 95% CI 0.090–0.786; p =0.017), distance from skin to insertion point ≥4.5cm (adjusted OR 0.342, 95% CI 0.134–0.868; p =0.024), and lumbosacral instrumentation (adjusted OR 0.227, 95% CI 0.091–0.566; p =0.001) were independently associated with intra-pedicular accuracy; the L5 insertion (adjusted OR 2.020, 95% CI 1.084–3.766; p =0.027) and facet angle ≥45° (adjusted OR 1.839, 95% CI 1.026–3.298; p =0.041) were independently associated with the proximal FJV.Conclusion TINAVI robot-assisted technique was associated with a high rate of pedicle screw placement and a low rate of proximal FJV. This new technique showed a safe and precise performance for pedicle screw placement in spinal surgery. Facet angle ≥45° is independently associated with both the intra-pedicular accuracy and proximal FJV.

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