scholarly journals Risk Factors of Unsatisfactory Robot-Assisted Pedicle Screw Placement: A Case-Control Study

Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 839-844
Author(s):  
Qi Zhang ◽  
Ming-Xing Fan ◽  
Xiao-Guang Han ◽  
Ya-Jun Liu ◽  
Da He ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pedicle Screw ◽  
Severe Obesity ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Potential Risk Factors ◽  
Screw Position

Objective: To identify potential risk factors of unsatisfactory screw position during robot-assisted pedicle screw fixation.Methods: A retrospective analysis of robot-assisted pedicle screw fixation performed in Beijing Jishuitan Hospital from March 2018 to March 2019 was conducted. Research data was collected from the medical record and imaging systems. Univariate tests were performed on the potential risk factors (patient’s characteristics and surgical factors) of unsatisfactory screw position during robot-assisted pedicle screw fixation. For statistically significant variables in univariate tests, a logistic regression test was used to identify independent risk factors for unsatisfactory screw position.Results: A total of 780 pedicle screws placed in 163 robot-assisted surgeries were analyzed. The rate of perfect screw positions was 93.08%, and the unsatisfactory rate was 6.92%. In patients with severe obesity (body mass index ≥ 30 kg/m<sup>2</sup>) (odds ratio [OR], 2.459; 95% confidence interval [CI], 1.199–5.044; p = 0.014), osteoporosis (T ≤ -2.5) (OR, 1.857; 95% CI, 1.046–3.295; p = 0.034), and the segments 3 levels away from the tracker (OR, 2.216; 95% CI, 1.119–4.387; p = 0.022), robot-assisted pedicle screw placement has a higher risk of screw malposition.Conclusion: During robot-assisted pedicle screw placement for patients with severe obesity, osteoporosis, and segments 3 levels away from the tracker, vigilance should be maintained during surgery to avoid postoperative complications due to unsatisfactory screw position.

scholarly journals Rates and Risk Factors of Intrapedicular Accuracy and Cranial Facet Joint Violation Among Robot- Assisted, Fluoroscopy-Guided Percutaneous, and Freehand Techniques in Pedicle Screw Fixation of Thoracolumbar Fractures: A Comparative Cohort Study

2021 ◽  
Author(s):  
Ren-Jie Zhang ◽  
Lu-Ping Zhou ◽  
Hua-Qing Zhang ◽  
Peng Ge ◽  
Chong-Yu Jia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pedicle Screw ◽  
Facet Joint ◽  
Pedicle Screw Fixation ◽  
Screw Placement ◽  
Thoracolumbar Fractures ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Facet Joint Osteoarthritis ◽  
Facet Joint Violation

Abstract Background Robot-assisted (RA) technique has been increasingly applied in clinical practice, providing promising outcomes of inserting accuracy and cranial facet joint protection. However, studies comparing this novel method with other assisted methods are rare, and the controversy of the superiority between the insertion techniques remains. Thus, we compare the rates and risk factors of intrapedicular accuracy and cranial facet joint violation (FJV) of RA, fluoroscopy-guided percutaneous (FP), and freehand (FH) techniques in the treatment of thoracolumbar fractures. Methods A total of 90 patients with thoracolumbar fractures requiring pedicle screw instruments were retrospectively included and divided into RA, FP, and FH groups at 1:1:1 ratio from June 2016 to May 2020. The primary outcomes were the intrapedicular accuracy and cranial FJV. The factors that affected the intrapedicular accuracy and cranial FJV were assessed using multivariate analyses.Results The optimal intrapedicular accuracy of pedicle screw placement (Grade A) in the RA, FP, and FH groups was 94.3%, 79.3%, and 88.7%, respectively. This finding indicates no significant differences between RA and FH techniques (P =0.062), but significantly higher accuracies of RA over FP (P＜0.001), and FH over FP (P= 0.013). In addition, the rates of proximal FJV in RA, FP, and FH groups were 13.9%, 29.3%, and 22.7%, respectively. The RA had a significantly greater proportion of intact facet joints than the FP (P= 0.001) and FH (P= 0.035). However, FP and FH showed significantly similar outcomes with respect to the proximal FJV (P= 0.149). The logistic regression analysis showed that FP technique (OR= 2.791), pedicle angle (OR= 0.916), and L3 insertion (OR= 0.081) were independently associated with insertion accuracy. Meanwhile, the age (OR= 0.966), pedicle angle (OR= 0.940), mild facet joint osteoarthritis (OR= 5.906), moderate facet joint osteoarthritis (OR= 5.906), severe facet joint osteoarthritis (OR= 9.991), and distance from skin to insertion point (OR= 0.575) were independently associated with cranial FJV.Conclusion RA technique showed higher rate of intrapedicular accuracy and lower rate of cranial FJV than FH and FP techniques, and it might be a safe method for pedicle screw placement in thoracolumbar surgery.

scholarly journals Comparison of the clinical efficacy of the Wiltse paraspinal approach and O-arm navigation for the treatment of thoracolumbar fractures

2020 ◽  
Author(s):  
Yingjie Lu ◽  
Tianfeng Zhu ◽  
Xu Shen ◽  
Yuepeng Fang ◽  
Dongdong Lu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Clinical Efficacy ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Fracture ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw ◽  
Paraspinal Approach

Abstract Background: To evaluate the clinical efficacy of the Wiltse paraspinal approach and percutaneous pedicle screw placement under O-arm navigation for the treatment of thoracolumbar fracture.Methods: We enrolled a total of 54 patients with neurologically intact thoracolumbar fracture who received minimally invasive treatment. Among these, 28 patients were treated with pedicle screw fixation through the Wiltse paraspinal approach (WPSF), and another 26 were received percutaneous pedicle screw fixation under O-arm navigation (OPSF). Statistical methods were used to perform a detailed comparison of clinical outcomes, radiologic findings and complications between the two groups obtained preoperatively, postoperatively and at last follow-up.Results: There were no significant differences between the two groups in terms of the intraoperative bleeding, length of incision, postoperative hospitalization durations or accuracy rate of pedicle screw placement (p>0.05). Visual analog scale (VAS) scores, Oswestry disability in­dex (ODI) scores, local Cobb angle (LCA), vertebral wedge angle (VWA) and R value were notably improved after surgery, though no clear discrepancy between the groups at each time point (p>0.05). However, the OPSF group had a longer operation time and greater surgical expenditure than the WPSF group (p<0.05).Conclusions: Both WPSF and OPSF were safe and effective for the treatment of thoracolumbar fracture. Although the two groups showed favorable clinical and radiologic outcomes through the final follow-up, we recommended the minimally invasive WPSF given its lower duration of surgery and medical costs. A randomized controlled study of high-quality and with a larger sample size is required to comfirm our findings in the future.

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

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.

Minimally Invasive Single-Position Lateral Interbody Fusion With Robotic Bilateral Percutaneous Pedicle Screw Fixation: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. E121-E121 ◽  
Author(s):  
Corey T Walker ◽  
Jakub Godzik ◽  
David S Xu ◽  
Nicholas Theodore ◽  
Juan S Uribe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Screw Placement ◽  
Lateral Interbody Fusion ◽  
Percutaneous Pedicle Screw ◽  
Percutaneous Pedicle Screw Fixation ◽  
Lateral Interbody

Abstract Lateral interbody fusion has distinct advantages over traditional posterior approaches. When adjunctive percutaneous pedicle screw fixation is required, placement from the lateral decubitus position theoretically increases safety and improves operative efficiency by obviating the need for repositioning. However, safe cannulation of the contralateral, down-side pedicles remains technically challenging and often prohibitive. In this video, we present the case of a 59-yr-old man with refractory back pain and bilateral lower extremity radiculopathy that was worse on the left than right side. The patient provided written informed consent before undergoing treatment. We performed minimally invasive single-position lateral interbody fusion with robotic (ExcelsiusGPS, Globus Medical Inc, Audubon, Pennsylvania) bilateral percutaneous pedicle screw fixation for the treatment of asymmetric disc degeneration, dynamic instability, and left paracentral disc herniation with corresponding stenosis at the L3-4 level. A left-sided minimally invasive transpsoas lateral interbody graft was placed with fluoroscopic guidance. Without changing the position of the patient or breaking the sterile field, an intraoperative cone-beam computed tomography image was obtained for navigational screw placement with stereotactic trackers in the iliac spine. Screw trajectories were planned using the robotic navigation software and were placed percutaneously in the bilateral L3 and L4 pedicles using the robotic arm. Concomitant lateral fluoroscopy may be used if desired to ensure the fidelity of the robotic guidance. The patient recovered well postoperatively and was discharged home within 36 h, without complication. Single-position lateral interbody fusion and percutaneous pedicle screw fixation can be accomplished using robotic-assisted navigation and pedicle screw placement. Used with permission from Barrow Neurological Institute.

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