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.
Axial twisting of the spine has been previously shown to be affected by scoliosis with decreased motion and asymmetric twisting. Existing methods for evaluating twisting may be cumbersome, unreliable, or require radiation exposure. In this study, we present an automated surface topographic measurement tool to evaluate global axial rotation of the spine, along with two measurements: twisting range of motion (TROM) and twisting asymmetry index (TASI). The aim of this study is to evaluate the impact of scoliosis on axial range of motion. Adolescent idiopathic scoliosis (AIS) patients and asymptomatic controls were scanned in a topographic scanner while twisting maximally to the left and right. TROM was significantly lower for AIS patients compared to control patients (69.1° vs. 78.5°, p = 0.020). TASI was significantly higher for AIS patients compared to control patients (29.6 vs. 19.8, p = 0.023). After stratifying by scoliosis severity, both TROM and TASI were significantly different only between control and severe scoliosis patients (Cobb angle > 40°). AIS patients were then divided by their major curve region (thoracic, thoracolumbar, or lumbar). ANOVA and post hoc tests showed that only TROM is significantly different between thoracic AIS patients and control patients. Thus, we demonstrate that surface topographic scanning can be used to evaluate twisting in AIS patients.
Background: Adolescent idiopathic scoliosis results in three dimensional changes to a patient’s body, which may change a patient’s range of motion. Surface topography is an emerging technology to evaluate three dimensional parameters in patients with scoliosis. The goal of this paper is to introduce novel and reliable surface topographic measurements for the assessment of global coronal and sagittal range of motion of the spine in adolescents, and to determine if these measurements can distinguish between adolescents with lumbar scoliosis and those without scoliosis. Methods: This study is a retrospective cohort study of a prospectively collected registry. Using a surface topographic scanner, a finger to floor and lateral bending scans were performed on each subject. Inter- and intra-rater reliabilities were assessed for each measurement. ANOVA analysis was used to test comparative hypotheses. Results: Inter-rater reliability for lateral bending fingertip asymmetry (LBFA) and lateral bending acromia asymmetry (LBAA) displayed poor reliability, while the coronal angle asymmetry (CAA), coronal angle range of motion (CAR), forward bending finger to floor (FBFF), forward bending acromia to floor (FBAF), sagittal angle (SA), and sagittal angle normalized (SAN) demonstrated good to excellent reliability. There was a significant difference between controls and lumbar scoliosis patients for LBFA, LBAA, CAA and FBAF (p-values < 0.01). Conclusion: Surface topography yields a reliable and rapid process for measuring global spine range of motion in the coronal and sagittal planes. Using these tools, there was a significant difference in measurements between patients with lumbar scoliosis and controls. In the future, we hope to be able to assess and predict perioperative spinal mobility changes.
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