Robot-Assisted Spine Surgery: A Solution for Aging Spine Surgeons

OBJECTIVE Robotics is a major area for research and development in spine surgery. The high accuracy of robot-assisted placement of thoracolumbar pedicle screws is documented in the literature. The authors present the largest case series to date evaluating 90-day complication, revision, and readmission rates for robot-assisted spine surgery using the current generation of robotic guidance systems. METHODS An analysis of a retrospective, multicenter database of open and minimally invasive thoracolumbar instrumented fusion surgeries using the Mazor X or Mazor X Stealth Edition robotic guidance systems was performed. Patients 18 years of age or older and undergoing primary or revision surgery for degenerative spinal conditions were included. Descriptive statistics were used to calculate rates of malpositioned screws requiring revision, as well as overall complication, revision, and readmission rates within 90 days. RESULTS In total, 799 surgical cases (Mazor X: 48.81%; Mazor X Stealth Edition: 51.19%) were evaluated, involving robot-assisted placement of 4838 pedicle screws. The overall intraoperative complication rate was 3.13%. No intraoperative implant-related complications were encountered. Postoperatively, 129 patients suffered a total of 146 complications by 90 days, representing an incidence of 16.1%. The rate of an unrecognized malpositioned screw resulting in a new postoperative radiculopathy requiring revision surgery was 0.63% (5 cases). Medical and pain-related complications unrelated to hardware placement accounted for the bulk of postoperative complications within 90 days. The overall surgical revision rate at 90 days was 6.63% with 7 implant-related revisions, representing an implant-related revision rate of 0.88%. The 90-day readmission rate was 7.13% with 2 implant-related readmissions, representing an implant-related readmission rate of 0.25% of cases. CONCLUSIONS The results of this multicenter case series and literature review suggest current-generation robotic guidance systems are associated with low rates of intraoperative and postoperative implant-related complications, revisions, and readmissions at 90 days. Future outcomes-based studies are necessary to evaluate complication, revision, and readmission rates compared to conventional surgery.

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Impact of robot-assisted spine surgery on health care quality and neurosurgical economics: A systemic review

Neurosurgical Review ◽

10.1007/s10143-018-0971-z ◽

2018 ◽

Vol 43 (1) ◽

pp. 17-25 ◽

Cited By ~ 15

Author(s):

Brian Fiani ◽

Syed A. Quadri ◽

Mudassir Farooqui ◽

Alessandra Cathel ◽

Blake Berman ◽

...

Keyword(s):

Health Care ◽

Spine Surgery ◽

Health Care Quality ◽

Care Quality ◽

Systemic Review ◽

Robot Assisted

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Initial academic experience and learning curve with robotic spine instrumentation

Neurosurgical FOCUS ◽

10.3171/2017.2.focus175 ◽

2017 ◽

Vol 42 (5) ◽

pp. E4 ◽

Cited By ~ 22

Author(s):

Timur M. Urakov ◽

Ken Hsuan-kan Chang ◽

S. Shelby Burks ◽

Michael Y. Wang

Keyword(s):

Pedicle Screw ◽

Spine Surgery ◽

Pedicle Screws ◽

Guidance System ◽

Screw Placement ◽

Fluoroscopy Time ◽

Academic Experience ◽

Robot Assisted ◽

Spine Instrumentation ◽

Significant Difference

OBJECTIVESpine surgery is complex and involves various steps. Current robotic technology is mostly aimed at assisting with pedicle screw insertion. This report evaluates the feasibility of robot-assisted pedicle instrumentation in an academic environment with the involvement of residents and fellows.METHODSThe Renaissance Guidance System was used to plan and execute pedicle screw placement in open and percutaneous consecutive cases performed in the period of December 2015 to December 2016. The database was reviewed to assess the usability of the robot by neurosurgical trainees. Outcome measures included time per screw, fluoroscopy time, breached screws, and other complications. Screw placement was assessed in patients with postoperative CT studies. The speed of screw placement and fluoroscopy time were collected at the time of surgery by personnel affiliated with the robot’s manufacturer. Complication and imaging data were reviewed retrospectively.RESULTSA total of 306 pedicle screws were inserted in 30 patients with robot guidance. The average time for junior residents was 4.4 min/screw and for senior residents and fellows, 4.02 min/screw (p = 0.61). Among the residents dedicated to spine surgery, the average speed was 3.84 min/screw, while nondedicated residents took 4.5 min/screw (p = 0.41). Evaluation of breached screws revealed some of the pitfalls in using the robot.CONCLUSIONSNo significant difference regarding the speed of pedicle instrumentation was detected between the operators’ years of experience or dedication to spine surgery, although more participants are required to investigate this completely. On the other hand, there was a trend toward improved efficiency with more cases performed. To the authors’ knowledge, this is the first reported academic experience with robot-assisted spine instrumentation.

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