140. Complications and revision rates in minimally invasive Mazor robotic-guided vs fluoroscopic-guided spinal fusions: the MIS ReFRESH prospective comparative study

Good, Christopher R.; Schroerlucke, Samuel R.; Cannestra, Andrew F.; Hsu, Victor; Zahrawi, Faissal; Lim, Jae Yol; Villalobos, Hunaldo; Ramirez, Pedro M.; Sweeney, Thomas M.; Wang, Michael Y.

doi:10.1016/j.spinee.2020.05.246

Cited by 11 publications

(15 citation statements)

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“…Two recent studies evaluated perioperative outcomes between robotic guidance (RG) and fluoro-guidance (FG) in adult lumbar fusions in the prospectively collected, multicenter MIS ReFRESH database [8,18]. Good et al [8] evaluated a total of 485 patients: 374 in the RG arm and 111 in the FG arm.…”

Section: Discussionmentioning

confidence: 99%

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A Multi-surgeon Robotic-guided Thoracolumbar Fusion Experience: Accuracy, Radiation, Complications, Readmissions, and Revisions of 3,874 Screws across Three Robotic Generations

Thomson

Orosz

Haines

et al. 2022

J Minim Invasive Spine Surg Tech

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Objective: Robotic guidance provides indirect visualization of key anatomic landmarks to facilitate minimally invasive surgery (MIS) and is emerging as a reliable and accurate technique for posterior spine instrumentation. We sought to describe eight years of experience with robotic guidance at a high-volume, multi-surgeon center. We hypothesize that robotic guidance will lead to (1) low rates of complication, readmissions, and revision surgery, (2) reduced fluoroscopic radiation exposure, (3) and accurate thoracolumbar instrumentation. Methods: A retrospective review of complications, revision surgery, and readmission rates in patients undergoing thoracolumbar fusion surgery utilizing three robotic generations. Secondary analysis was conducted comparing the three robotic generations for complications, revision surgery, accuracy, and readmission rates along with intraoperative fluoroscopic duration. Results: A total of 628 patients (3,874 robotic-guided screws) ages 12-81 years-old (43.9% male) were included in the study. At one year, the cumulative complication incidence was 15.5% with a 10.3% incidence of surgical complications (3.7% wound, 1.2% robot-related, and 5.4% non-robot-related complications). At one year, the revision surgery incidence was 9.4%. There was no statistical difference between complications, readmission, or revision surgery after initial admission among the three robotic generations. The average intraoperative fluoroscopic duration was 53.8 seconds (11.9 seconds per screw and 17.6 seconds per instrumented level). Conclusion: Robotic guidance in thoracolumbar instrumented fusions was associated with low complication, revision surgery, and readmission rates. Our results suggest robotic guidance can provide accurate guidance with minimal adverse events in thoracolumbar instrumentation.

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Section: Discussionmentioning

confidence: 99%

“…The current literature suggests that robotic guidance systems can be used to perform reliable and accurate thoracolumbar pedicle instrumentation [5][6][7][8]. However, significant variation between robotic technology over time and individual proprietary robotics systems introduces significant heterogeneity in the body of research.…”

Section: Introductionmentioning

confidence: 99%

A Multi-surgeon Robotic-guided Thoracolumbar Fusion Experience: Accuracy, Radiation, Complications, Readmissions, and Revisions of 3,874 Screws across Three Robotic Generations

Thomson

Orosz

Haines

et al. 2022

J Minim Invasive Spine Surg Tech

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“…These ndings have been since validated in studies using the newer Mazor X robotic guidance platform, which has an option of combination with intraoperative CT-based spinal navigation as reported by Khan et al (2018) in 50 patients with degenerative disc disease who underwent robot guided placement of 190 pedicle screws achieving an accuracy rate of 99.5% [22]. Recently, initial results from a high-power multicenter prospective study from the U.S. MIS-ReFRESH compared 374 Mazor robotic-guided to 111 uoroscopic guided minimally invasive spinal fusions and found Mazor robotic-guided had 5.2 fold lower risk of surgical complications and 8.8 fold lower risk for revision surgery [23]. While a similar multi-center prospective comparative European Robotic Spinal Instrumentation study (EUROSPIN) is still ongoing [24].…”

Section: Discussionmentioning

confidence: 99%

When Giants Talk; Robotic Dialog During Thoracolumbar and Sacral Surgery

Schroeder

Houri

Weil

et al. 2021

Preprint

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Background: First spinal trauma patients treated in a specialized hybrid operating room (OR) using two robotic systems communicating during surgery.Methods: Retrospective review of patients with thoracolumbar or sacral fractures who underwent surgical fixation between Jan 2017 to Jan 2020 with robotic-guided percutaneous pedicle screw insertion in the specialized hybrid OR with Robotic flat panel 3D C-arm (ArtisZeego) for intraoperative interventional imaging connected with the robotic-guidance platform Renaissance (Mazor Robotics).Results: Twenty eight surgeries were performed in 27 patients; 23 with traumatic spinal fractures, 4 with multi-level thoracolumbar compression fractures due to severe osteoporosis. Average patient age 49 (range 12-86). Average radiation exposure time 40sec (range 12-114 sec). Average radiation exposure dose 11,584±SD uGym2 (range 4,454- 58,959). Lumber levels operated on were between T5 and S2 (shortest three vertebras and longest eight vertebras). 235 (range 5-11) trajectories were performed. All trajectories were accurate in all cases percutaneous pedicle screws placement was correct, without breach noted at the pedicle in any of the cases. No major complications reported. In all cases, follow-up x-rays showed adequate fracture reduction with restoration.Conclusions: Merging of surgical robotics technologies increases patient safety and surgeon and patient confidence in percutaneous spine traumatic procedures.

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“…While navigation and robotic guidance require a technological leap of faith compared with the foundational fluoroscopic guidance technique, they have proven to be safe and reliable techniques for the patient and the surgeon. 80,81 In a multicenter prospective study comparing short term complication and revision rates in MIS robotic guided and fluoroscopic guided lumbar fusions, the robot cases were found to have a 5.8 (95% CI: 3.5-9.6; P < 0.001) times lower risk of surgical complication, a 11.0 (95% CI: 2.9-41.2; P < 0.001) times lower risk for revision surgery, and approximately an 80% reduction (1 min per case) fluoroscopy time. 80 Although robotic and fluoroscopic techniques may have comparable levels of accuracy, the preoperative planning aspect of robotic assistance enables patient-specific simulation to optimize implant size and trajectory.…”

Section: Emerging Applications Minimally Invasive Techniquesmentioning

confidence: 99%

Robotic Spine Surgery: Past, Present and Future.

Perfetti

Kisinde

Rogers-LaVanne

et al. 2022

Spine

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Study Design. Systematic review. Objective. The aim of this review is to present an overview of robotic spine surgery (RSS) including its history, applications, limitations, and future directions. Summary of Background Data. The first RSS platform received United States Food and Drug Administration approval in 2004. Since then, robotic-assisted placement of thoracolumbar pedicle screws has been extensively studied. More recently, expanded applications of RSS have been introduced and evaluated. Methods. A systematic search of the Cochrane, OVID-MEDLINE, and PubMed databases was performed for articles relevant to robotic spine surgery. Institutional review board approval was not needed. Results. The placement of thoracolumbar pedicle screws using RSS is safe and accurate and results in reduced radiation exposure for the surgeon and surgical team. Barriers to utilization exist including learning curve and large capital costs. Additional applications involving minimally invasive techniques, cervical pedicle screws, and deformity correction have emerged. Conclusion. Interest in RSS continues to grow as the applications advance in parallel with image guidance systems and minimally invasive techniques. IRB Approval. N/A.

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140. Complications and revision rates in minimally invasive Mazor robotic-guided vs fluoroscopic-guided spinal fusions: the MIS ReFRESH prospective comparative study

Cited by 11 publications

References 0 publications

A Multi-surgeon Robotic-guided Thoracolumbar Fusion Experience: Accuracy, Radiation, Complications, Readmissions, and Revisions of 3,874 Screws across Three Robotic Generations

A Multi-surgeon Robotic-guided Thoracolumbar Fusion Experience: Accuracy, Radiation, Complications, Readmissions, and Revisions of 3,874 Screws across Three Robotic Generations

When Giants Talk; Robotic Dialog During Thoracolumbar and Sacral Surgery

Robotic Spine Surgery: Past, Present and Future.

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