Accuracy and safety of robot-assisted cortical bone trajectory screw placement: a comparison of robot-assisted technique with fluoroscopy-assisted approach

Li, Yue; Chen, Long; Liu, Yuzeng; Ding, Hongtao; Lu, Hongyi; Pan, Aixing; Zhang, Xinuo; Hai, Yong; Guan, Li

doi:10.1186/s12891-022-05206-y

Cited by 22 publications

(40 citation statements)

References 30 publications

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“…3D printed navigation template was investigated by our team previously and demonstrated that it improves the accuracy of the MCBT screw placement [ 40 ]. Currently, CBT screws combined with robotic screw placement have become a safe and effective method with the advantages of precise screw insertion and minimal trauma [ 41 , 42 ]. In addition, emerging artificial intelligence (AI) technology plays an important role in solving many problems faced in spine surgery [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, CBT screws combined with robotic screw placement have become a safe and effective method with the advantages of precise screw insertion and minimal Fig. 3 Length of the CBT screw within the vertebral body and the total length [16] trauma [41,42]. In addition, emerging artificial intelligence (AI) technology plays an important role in solving many problems faced in spine surgery [43].…”

Section: Length Of the Screw Pathmentioning

confidence: 99%

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Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory

et al. 2022

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Background To compare the CT values and length of the screw tracks of traditional trajectory (TT), cortical bone trajectory (CBT), and modified cortical bone trajectory (MCBT) screws and investigate the effects on the biomechanics of lumbar fixation. Methods CT scan data of 60 L4 and L5 lumbar spine were retrieved and divided into 4 groups (10 male and 10 female cases in the 20–30 years old group and 20 male and 20 female cases in the 30–40 years old group). 3-dimentional (3D) model were established using Mimics 19.0 for each group and the placement of three techniques was simulated on the L4 and L5, and the part of the bone occupied by the screw track was set as the region of interest (ROI). The mean CT value and the actual length of the screw track were measured by Mimics 19.0. Results The CT values of ROI for the three techniques were significantly different between the same gander in each age group (P < 0.05). The difference of screw track lengths for CBT and MCBT in the male and female is significant (P < 0.05). Conclusions According to the CT values of the three screw tracks: MCBT > CBT > TT, the MCBT screw track has greater bone-screw surface strength and longer screw tracks than CBT, which is easier to reach the anterior column of the vertebral body contributing to superior biomechanical properties.

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Section: Discussionmentioning

confidence: 99%

Section: Length Of the Screw Pathmentioning

confidence: 99%

Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory

et al. 2022

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“…In recent years, robotic-assisted CBT screw placement has been reported. Li et al reported that the accuracy of the CBT screw placement was higher in robotics than that in fluoroscopy [ 16 ]. Le et al found that 87.2% of the CBT screws were in the perfect position (Grade A) with robotics, and the percentage of clinically acceptable screws (Grade A or B) was higher in robotics than that in fluoroscopy [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Due to the difference from the traditional PS trajectory, computer-assisted devices such as navigation [4][5][6][7] and three-dimensional (3D)-printed templates [8][9][10][11] are being used. Furthermore, recently, robotic-assisted spine surgery has been performed, which is expected to contribute to improving the safety of the CBT screw [12][13][14][15][16].…”

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confidence: 99%

Accuracy and Screw Insertion Time of Robotic-Assisted Cortical Bone Trajectory Screw Placement for Posterior Lumbar Interbody Fusion: A Comparison of Early, Middle, and Late Phases

Ueno¹,

Akazawa²,

Torii³

et al. 2022

Cureus

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The purpose of this study was to evaluate robotic-assisted cortical bone trajectory (CBT) screw placement. Early, middle, and late phases of robotic-assisted CBT screw placement were compared for accuracy and screw insertion time by comparing time and accuracy in every phase. MethodsA retrospective review was conducted on the initial 40 patients who underwent spinal fusion using CBT screws in one institution from September 2021 to September 2022 utilizing a spine surgery robot system (Mazor X Stealth Edition, Medtronic Inc., Dublin, Ireland). The inclusion criterion was one-or two-level posterior lumbar interbody fusion (PLIF). Exclusion criteria were 1) patients who underwent posterior-lateral fusion in other segments, 2) patients who underwent additional decompression in other segments, 3) patients who underwent reoperation, and 4) patients with spondylolysis. The deviation of the CBT screw was evaluated on computed tomography (CT) one week after surgery using the Gertzbein-Robbins grade system. The rate of Grade A was considered the perfect accuracy rate, and the rate of penetration of 2 mm or more (Grades C, D, and E) was calculated as the deviation rate. To assess the learning curve, patients were divided into three groups. The first 10 cases were in the early phase group, the subsequent 10 cases were in the middle phase group, and the last 10 cases were in the late phase group. We compared the perfect accuracy rate, deviation rate, operative time, operative time per segment, intraoperative blood loss, registration time, and screw insertion time among the three groups. ResultsThirty patients met the criteria. Overall, the perfect accuracy (Grade A) rate of the screw was 95.3% and the deviation rate was 1.4%. The perfect accuracy rate was 90.4% in the early phase, 95.5% in the middle phase, and 100% in the late phase. The deviation rate was 3.8% in the early phase, 0% in the middle phase, and 0% in the late phase, and there was no statistically significant difference between the three groups. Among the three groups, the operative time, the operative time per segment, the intraoperative blood loss, and the registration time were not significantly different. There was no significant difference in the screw insertion time among the three groups, but it decreased with experience (early phase: 156.9 ± 54.7 sec, middle phase: 139.9 ± 41.6 sec, and late phase: 106.4 ± 39.9 sec, p=0.060). The screw insertion time of the late phase tended to be shorter than that of the early phase (p=0.052). ConclusionsThe deviation rate of robotic-assisted CBT screw placement with one-or two-level PLIF was 1.4%, which was highly accurate. The deviation rate was 3.8% in the early phase, 0% in the middle phase, and 0% in the late phase. Although the deviation rate was low even in the early period, the screw insertion time in the early 10 cases tended to be longer than that in the late 10 cases. After passing the experience of 10 cases, this study concluded that robotic-assisted CBT screw placement was proficient.

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“…Robot-assisted spinal surgery has also been applied in clinical practice [ 8 ]. It has been confirmed to be superior to manual operations in terms of safety, accuracy, the amount of radiation to surgeons, and the learning curve [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Development and Clinical Trial of a New Orthopedic Surgical Robot for Positioning and Navigation

Chang

et al. 2022

JCM

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Robot-assisted orthopedic surgery has great application prospects, and the accuracy of the robot is the key to its overall performance. The aim of this study was to develop a new orthopedic surgical robot to assist in spinal surgeries and to compare its feasibility and accuracy with the existing orthopedic robot. A new type of high-precision orthopedic surgical robot (Tuoshou) was developed. A multicenter, randomized controlled trial was carried out to compare the Tuoshuo with the TiRobot (TINAVI Medical Technologies Co., Ltd., Beijing) to evaluate the accuracy and safety of their navigation and positioning. A total of 112 patients were randomized, and 108 patients completed the study. The position deviation of the Kirschner wire placement in the Tuoshuo group was smaller than that in the TiRobot group (p = 0.014). The Tuoshuo group was better than the TiRobot group in terms of the pedicle screw insertion accuracy (p = 0.016) and entry point deviation (p < 0.001). No differences were observed in endpoint deviation (p = 0.170), axial deviation (p = 0.170), sagittal deviation (p = 0.324), and spatial deviation (p = 0.299). There was no difference in security indicators. The new orthopedic surgical robot was highly accurate and optimized for clinical practice, making it suitable for clinical application.

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Accuracy and safety of robot-assisted cortical bone trajectory screw placement: a comparison of robot-assisted technique with fluoroscopy-assisted approach

Cited by 22 publications

References 30 publications

Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory

Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory

Accuracy and Screw Insertion Time of Robotic-Assisted Cortical Bone Trajectory Screw Placement for Posterior Lumbar Interbody Fusion: A Comparison of Early, Middle, and Late Phases

Development and Clinical Trial of a New Orthopedic Surgical Robot for Positioning and Navigation

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