Clinical Outcomes of Robotic Versus Freehand Pedicle Screw Placement After One-to Three-Level Lumbar Fusion

2021 ◽  
pp. 219256822110574
Author(s):  
Brian A. Karamian ◽  
Stephen L. DiMaria ◽  
Andrew N. Sawires ◽  
Jose A. Canseco ◽  
Bryce A. Basques ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Surgical Outcomes ◽  
Lumbar Fusion ◽  
Linear Regression Analysis ◽  
Patient Reported Outcome Measures ◽  
Screw Placement ◽  
Multivariate Linear Regression Analysis ◽  
Pedicle Screw Placement ◽  
Minimally Clinically Important Difference ◽  
Patient Reported

Study Design Retrospective cohort study Objectives The purpose of this study is to compare patient-reported outcome measures (PROMs) for patients undergoing one-to three-level lumbar fusion using robotically assisted vs freehand pedicle screw placement. Methods Patients who underwent either robotically assisted or freehand pedicle screw placement for one-to three-level lumbar fusion surgery from January 1, 2014 to August 31, 2020 at a single academic institution were identified. Propensity score matching was performed based on demographic variables. Clinical and surgical outcomes were compared between groups. Recovery Ratios (RR) and the proportion of patients achieving the minimally clinically important difference (%MCID) were calculated for Oswestry Disability Index, PCS-12, MCS-12, VAS Back, and VAS Leg at 1 year. Surgical outcomes included complication and revision rates. Results A total of 262 patients were included in the study (85 robotic and 177 freehand). No significant differences were found in ΔPROM scores, RR, or MCID between patients who underwent robotically assisted vs freehand screw placement. The rates of revision (1.70% freehand vs 1.18% robotic, P = 1.000) and complications (.57% freehand vs 1.18% robotic, P = .546) were not found to be statically different between the 2 groups. Controlling for demographic factors, procedure type (robotic vs freehand) did not emerge as a significant predictor of ΔPROM scores on multivariate linear regression analysis. Conclusions Robotically assisted pedicle screw placement did not result in significantly improved clinical or surgical outcomes compared to conventional freehand screw placement for patients undergoing one-to three-level lumbar fusion.

Clinical Assessment of Percutaneous Lumbar Pedicle Screw Placement Using the O-Arm Multidimensional Surgical Imaging System

Neurosurgery ◽  
2011 ◽  
Vol 70 (4) ◽  
pp. 990-995 ◽  
Author(s):  
John K. Houten ◽  
Rani Nasser ◽  
Nrupen Baxi
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Imaging System ◽  
Intraoperative Imaging ◽  
Lumbar Fusion ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw ◽  
Clinical Series

Abstract BACKGROUND: Increasing popularity of minimally invasive surgery for lumbar fusion has led to dependence upon intraoperative fluoroscopy for pedicle screw placement, because limited muscle dissection does not expose the bony anatomy necessary for traditional, freehand techniques nor for registration steps in image-guidance techniques. This has raised concerns about cumulative radiation exposure for both surgeon and operating room staff. The recent introduction of the O-arm Multidimensional Surgical Imaging System allows for percutaneous placement of pedicle screws, but there is limited clinical experience with the technique and data examining its accuracy. OBJECTIVE: We present the first large clinical series of percutaneous screw placement using navigation of O-arm imaging and compare the results with the fluoroscopy-guided method. METHODS: A retrospective review of a 24-month period identified patients undergoing minimally invasive lumbar interbody fusion. The O-arm was introduced in the middle of this period and was used for all subsequent patients. Accuracy of screw placement was assessed by examination of axial computed tomography or O-arm scans. RESULTS: The fluoroscopy group included 141 screws in 42 patients, and the O-arm group included 205 screws in 52 patients. The perforation rate was 12.8% in the fluoroscopy group and 3% in the O-arm group (P < .001). Single-level O-arm procedures took a mean 200 (153–241) minutes, whereas fluoroscopy took 221 (178–302) minutes (P < .03). CONCLUSION: Percutaneous pedicle screw placement with the O-arm Multidimensional Intraoperative Imaging System is a safe and effective technique and provided improved overall accuracy and reduced operative time compared with conventional fluoroscopic techniques.

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.

scholarly journals Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery?

2022 ◽  
Vol 52 (1) ◽  
pp. E4
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Surgical Navigation ◽  
Lumbar Fusion ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Robotic Assistance ◽  
Pedicle Screw Placement ◽  
Screw Length ◽  
The Mean

OBJECTIVE The accuracy of percutaneous pedicle screw placement has increased with the advent of robotic and surgical navigation technologies. However, the effect of robotic intraoperative screw size and trajectory templating remains unclear. The purpose of this study was to compare pedicle screw sizes and accuracy of placement using robotic navigation (RN) versus skin-based intraoperative navigation (ION) alone in minimally invasive lumbar fusion procedures. METHODS A retrospective cohort study was conducted using a single-institution registry of spine procedures performed over a 4-year period. Patients who underwent 1- or 2-level primary or revision minimally invasive surgery (MIS)–transforaminal lumbar interbody fusion (TLIF) with pedicle screw placement, via either robotic assistance or surgical navigation alone, were included. Demographic, surgical, and radiographic data were collected. Pedicle screw type, quantity, length, diameter, and the presence of endplate breach or facet joint violation were assessed. Statistical analysis using the Student t-test and chi-square test was performed to evaluate the differences in pedicle screw sizes and the accuracy of placement between both groups. RESULTS Overall, 222 patients were included, of whom 92 underwent RN and 130 underwent ION MIS-TLIF. A total of 403 and 534 pedicle screws were placed with RN and ION, respectively. The mean screw diameters were 7.25 ± 0.81 mm and 6.72 ± 0.49 mm (p < 0.001) for the RN and ION groups, respectively. The mean screw length was 48.4 ± 4.48 mm in the RN group and 45.6 ± 3.46 mm in the ION group (p < 0.001). The rates of “ideal” pedicle screws in the RN and ION groups were comparable at 88.5% and 88.4% (p = 0.969), respectively. The overall screw placement was also similar. The RN cohort had 63.7% screws rated as good and 31.4% as acceptable, while 66.1% of ION-placed screws had good placement and 28.7% had acceptable placement (p = 0.661 and p = 0.595, respectively). There was a significant reduction in high-grade breaches in the RN group (0%, n = 0) compared with the ION group (1.2%, n = 17, p = 0.05). CONCLUSIONS The results of this study suggest that robotic assistance allows for placement of screws with greater screw diameter and length compared with surgical navigation alone, although with similarly high accuracy. These findings have implied that robotic platforms may allow for safe placement of the “optimal screw,” maximizing construct stability and, thus, the ability to obtain a successful fusion.

Accuracy of Pedicle Screw Placement for Lumbar Fusion using Anatomic Landmarks versus Open Laminectomy: A Comparison of Two Surgical Techniques in Cadaveric Specimens

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-13-ONS-19 ◽  
Author(s):  
Aftab Karim ◽  
Debi Mukherjee ◽  
Jorge Gonzalez-Cruz ◽  
Alan Ogden ◽  
Donald Smith ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Lumbar Fusion ◽  
Entry Point ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Anatomic Landmarks ◽  
Computed Tomographic ◽  
Entry Points ◽  
Tomographic Analysis ◽  
The Ideal

Abstract OBJECTIVE: We determined whether the accuracy of lumbar pedicle screw placement is optimized by performing a laminectomy before screw placement with screw entry point and trajectory being guided by pedicle visualization and palpation (Technique 1). This technique was compared with a technique using anatomic landmarks for pedicle screw placement (Technique 2). The biomechanical stability of the instrumented constructs, in the absence and presence of a laminectomy, was also compared. METHODS: Twelve L1–L3 specimens were harvested from fresh cadavers. The intact laminectomy and instrumented spines were biomechanically tested in flexion and extension, lateral bending, and axial rotation. Laminectomies were performed in six of the 12 specimens before pedicle screw placement using Technique 1. The remaining six specimens underwent pedicle screw and rod fixation using Technique 2. Computed tomographic images were obtained for all instrumented specimens. Deviation of the screws from the ideal entry point or trajectory was analyzed to quantitatively compare the two techniques. RESULTS: Computed tomographic analysis of the specimens showed that all screw placements were within the pedicles. Scatter plot analysis demonstrated that screws placed using Technique 2 were more likely to have the combination of entry points and trajectories medial to the ideal entry point and trajectory. Laminectomy did not weaken the final pedicle screw and rod-fixated constructs. CONCLUSION: All screw placements were grossly within the confines of the pedicles, regardless of technique, as evidenced by computed tomographic analysis. Furthermore, the anatomic landmark technique and the open laminectomy technique yielded biomechanically equivalent pedicle screw and rod-fixated constructs.

Accuracy and technical limits of percutaneous pedicle screw placement in the thoracolumbar spine

2021 ◽  
Author(s):  
Yann Philippe Charles ◽  
Yves Ntilikina ◽  
Arnaud Collinet ◽  
Sébastien Schuller ◽  
Julien Garnon ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracolumbar Spine ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw

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.

Sign in / Sign up

Export Citation Format

Share Document