Biomechanical advantages of robot-assisted pedicle screw fixation in posterior lumbar interbody fusion compared with freehand technique in a prospective randomized controlled trial—perspective for patient-specific finite element analysis

Kim, Ho-Joong; Kang, Kyoung‐Tak; Park, Sung Cheol; Kwon, Oh Hyo; Son, Jung–Woo; Chang, Bong Soon; Lee, Choon-Ki; Yeom, Jin S.; Lenke, Lawrence G.

doi:10.1016/j.spinee.2016.11.010

Cited by 35 publications

(23 citation statements)

References 33 publications

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“…This result might be associated with a previous report from the present clinical trial, which showed fewer proximal facet joint violations, greater distance between pedicle screw and proximal facet joint surface, and fewer hazardous orientations with Robot‐assisted pedicle screw fixation. Another biomechanical study also reported significantly less facet contact force in the robot‐assisted pedicle screw fixation than in the Freehand‐PLIF group . However, the present study would not constitute definite evidence for less stress in the proximal adjacent segment in the Robot‐PLIF group, but also does not indicate a lower prevalence of adjacent segment degeneration with Robot‐PLIF, because the present study included radiological data for only 1 year after surgery.…”

Section: Discussioncontrasting

confidence: 53%

Comparative study of 1‐year clinical and radiological outcomes using robot‐assisted pedicle screw fixation and freehand technique in posterior lumbar interbody fusion: A prospective, randomized controlled trial

Kim

Kang

Chun

et al. 2018

Robotics Computer Surgery

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Section: Discussioncontrasting

confidence: 53%

Comparative study of 1‐year clinical and radiological outcomes using robot‐assisted pedicle screw fixation and freehand technique in posterior lumbar interbody fusion: A prospective, randomized controlled trial

Kim

Kang

Chun

et al. 2018

Robotics Computer Surgery

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“…They found that the proximal FJV was significantly different between the robotic and freehand groups, with less FJV and larger facet to screw distance in the robotic group. In a finite element analysis, Kim et al . showed the biomechanical advantages of RA pedicle screw insertion in terms of alleviation of stress concentration at proximal adjacent segments after fusion surgery, compared with pedicle screw insertion using the freehand technique.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Superior‐Level Facet Joint Violations Between Robot‐Assisted Percutaneous Pedicle Screw Placement and Conventional Open Fluoroscopic‐Guided Pedicle Screw Placement

Zhang

Tian

et al. 2019

Orthopaedic Surgery

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Objective To compare the superior‐level facet joint violations (FJV) between robot‐assisted (RA) percutaneous pedicle screw placement and conventional open fluoroscopic‐guided (FG) pedicle screw placement in a prospective cohort study. Methods This was a prospective cohort study without randomization. One‐hundred patients scheduled to undergo RA (n = 50) or FG (n = 50) transforaminal lumbar interbody fusion were included from February 2016 to May 2018. The grade of FJV, the distance between pedicle screws and the corresponding proximal facet joint, and intra‐pedicle accuracy of the top screw were evaluated based on postoperative CT scan. Patient demographics, perioperative outcomes, and radiation exposure were recorded and compared. Perioperative outcomes include surgical time, intraoperative blood loss, postoperative length of stay, conversion, and revision surgeries. Results Of the 100 screws in the RA group, 4 violated the proximal facet joint, while 26 of 100 in the FG group had FJV (P = 0.000). In the RA group, 3 and 1 screws were classified as grade 1 and 2, respectively. Of the 26 FJV screws in the FG group, 17 screws were scored as grade 1, 6 screws were grade 2, and 3 screws were grade 3. Significantly more severe FJV were noted in the FG group than in the RA group (P = 0.000). There was a statistically significant difference between RA and FG for overall violation grade (0.05 vs 0.38, P = 0.000). The average distance of pedicle screws from facet joints in the RA group (4.16 ± 2.60 mm) was larger than that in the FG group (1.92 ± 1.55 mm; P = 0.000). For intra‐pedicle accuracy, the rate of perfect screw position was greater in the RA group than in the FG group (85% vs 71%; P = 0.017). No statistically significant difference was found between the clinically acceptable screws between groups (P = 0.279). The radiation dose was higher in the FG group (30.3 ± 11.3 vs 65.3 ± 28.3 μSv; P = 0.000). The operative time in the RA group was significantly longer (184.7 ± 54.3 vs 117.8 ± 36.9 min; P = 0.000). Conclusions Compared to the open FG technique, minimally invasive RA spine surgery was associated with fewer proximal facet joint violations, larger facet to screw distance, and higher intra‐pedicle accuracy.

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“…21 In addition to accuracy through the pedicle, some studies suggested that using robotics for pedicle screw placement allows the surgeon to avoid violating the proximal facet joint, which may provide biomechanical advantages that could preclude the development of adjacent-segment disease. 16 There are no large-scale studies to date that have directly compared robotic guidance of pedicle screws with image guidance. Roser et al did publish a preliminary series evaluating image guidance in comparison with both robotics and freehand placement.…”

Section: Discussionmentioning

confidence: 99%

Current applications of robotics in spine surgery: a systematic review of the literature

Joseph

Smith

2017

Neurosurgical Focus

165

144

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OBJECTIVESurgical robotics has demonstrated utility across the spectrum of surgery. Robotics in spine surgery, however, remains in its infancy. Here, the authors systematically review the evidence behind robotic applications in spinal instrumentation.METHODSThis systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Relevant studies (through October 2016) that reported the use of robotics in spinal instrumentation were identified from a search of the PubMed database. Data regarding the accuracy of screw placement, surgeon learning curve, radiation exposure, and reasons for robotic failure were extracted.RESULTSTwenty-five studies describing 2 unique robots met inclusion criteria. Of these, 22 studies evaluated accuracy of spinal instrumentation. Although grading of pedicle screw accuracy was variable, the most commonly used method was the Gertzbein and Robbins system of classification. In the studies using the Gertzbein and Robbins system, accuracy (Grades A and B) ranged from 85% to 100%. Ten studies evaluated radiation exposure during the procedure. In studies that detailed fluoroscopy usage, overall fluoroscopy times ranged from 1.3 to 34 seconds per screw. Nine studies examined the learning curve for the surgeon, and 12 studies described causes of robotic failure, which included registration failure, soft-tissue hindrance, and lateral skiving of the drill guide.CONCLUSIONSRobotics in spine surgery is an emerging technology that holds promise for future applications. Surgical accuracy in instrumentation implanted using robotics appears to be high. However, the impact of robotics on radiation exposure is not clear and seems to be dependent on technique and robot type.

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Biomechanical advantages of robot-assisted pedicle screw fixation in posterior lumbar interbody fusion compared with freehand technique in a prospective randomized controlled trial—perspective for patient-specific finite element analysis

Cited by 35 publications

References 33 publications

Comparative study of 1‐year clinical and radiological outcomes using robot‐assisted pedicle screw fixation and freehand technique in posterior lumbar interbody fusion: A prospective, randomized controlled trial

Comparative study of 1‐year clinical and radiological outcomes using robot‐assisted pedicle screw fixation and freehand technique in posterior lumbar interbody fusion: A prospective, randomized controlled trial

Comparison of Superior‐Level Facet Joint Violations Between Robot‐Assisted Percutaneous Pedicle Screw Placement and Conventional Open Fluoroscopic‐Guided Pedicle Screw Placement

Current applications of robotics in spine surgery: a systematic review of the literature

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