Bone-mounted Miniature Robotic Guidance for Pedicle Screw and Translaminar Facet Screw Placement

Lieberman, Isador H.; Togawa, Daisuke; Kayanja, Mark; Reinhardt, Mary Kay; Friedlander, A.; Knoller, Nachshon; Benzel, Edward C.

doi:10.1227/01.neu.0000229055.00829.5b

Cited by 163 publications

(121 citation statements)

References 58 publications

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“…This is connected to the central processing unit (CPU), which is essentially a computer that integrates the preoperative CT scan to the intraoperative radiographic image. 32 The accuracy of pedicle screw placement has been quite phenomenal. Currently, there are only a handful of clinical trials of robotic technology in neurosurgery, with a major emphasis in spine surgery.…”

Section: 45mentioning

confidence: 99%

Augmented-reality integrated robotics in neurosurgery: are we there yet?

Madhavan¹,

Kolcun²,

Chieng³

et al. 2017

Neurosurgical Focus

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Surgical robots have captured the interest—if not the widespread acceptance—of spinal neurosurgeons. But successful innovation, scientific or commercial, requires the majority to adopt a new practice. “Faster, better, cheaper” products should in theory conquer the market, but often fail. The psychology of change is complex, and the “follow the leader” mentality, common in the field today, lends little trust to the process of disseminating new technology. Beyond product quality, timing has proven to be a key factor in the inception, design, and execution of new technologies. Although the first robotic surgery was performed in 1985, scant progress was seen until the era of minimally invasive surgery. This movement increased neurosurgeons’ dependence on navigation and fluoroscopy, intensifying the drive for enhanced precision. Outside the field of medicine, various technology companies have made great progress in popularizing co-robots (“cobots”), augmented reality, and processor chips. This has helped to ease practicing surgeons into familiarity with and acceptance of these technologies. The adoption among neurosurgeons in training is a “follow the leader” phenomenon, wherein new surgeons tend to adopt the technology used during residency. In neurosurgery today, robots are limited to computers functioning between the surgeon and patient. Their functions are confined to establishing a trajectory for navigation, with task execution solely in the surgeon’s hands. In this review, the authors discuss significant untapped technologies waiting to be used for more meaningful applications. They explore the history and current manifestations of various modern technologies, and project what innovations may lie ahead.

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Section: 45mentioning

confidence: 99%

Augmented-reality integrated robotics in neurosurgery: are we there yet?

Madhavan¹,

Kolcun²,

Chieng³

et al. 2017

Neurosurgical Focus

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show abstract

“…Details of the device and related surgical techniques have been described previously [7,10,12,14]. A CT scan using 1 mm cuts was obtained preoperatively in all patients for the surgery planning using the proprietary robotic software (Fig.…”

Section: Robotic Guidance System and Surgical Techniquesmentioning

confidence: 99%

“…The need for improved accuracy and consistency in pedicle screw placement has led to the development of various new techniques, such as computer navigated and robotic-assisted spine surgery [7][8][9][10][11]. There are now reports showing that these newer techniques have improved the accuracy of pedicle screw placement [5,12,13].…”

Section: Introductionmentioning

confidence: 99%

“…There are now reports showing that these newer techniques have improved the accuracy of pedicle screw placement [5,12,13]. Computer-assisted robotic devices are now available in the form of a bone mounted positioning tool that guides the surgeon in the placement of pedicle screws according to a preoperatively planned trajectory (Renaissance, Mazor Robotics Ltd., Israel) [7,10]. This new technology is continually improving and may be particularly useful in patients with challenging anatomy.…”

Section: Introductionmentioning

confidence: 99%

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Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients

2012

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Introduction Surgeons' interest in image and/or robotic guidance for spinal implant placement is increasing. This technology is continually improving and may be particularly useful in patients with challenging anatomy. Only through careful clinical evaluation can its successful applications, limitations, and areas for improvement be defined. This study evaluates the outcomes of robotic-assisted screw placement in a consecutive series of 102 patients. Methods Data were recorded from technical notes and operative records created immediately following each surgery case, in which the robotic system was used to guide pedicle screw placement. All cases were performed at the same hospital by a single surgeon. The majority of patients had spinal deformity and/or previous spine surgery. Each planned screw placement was classified as: (1) successful/ accurately placed screw using robotic guidance; (2) screw malpositioned using robot; (3) use of robot aborted and screw placed manually; (4) planned screw not placed as screw deemed non essential for construct stability. Data from each case were reviewed by two independent researchers to indentify the diagnosis, number of attempted robotic guided screw placements and the outcome of the attempted placement as well as complications or reasons for non-placement. Results Robotic-guided screw placement was successfully used in 95 out of 102 patients. In those 95 patients, 949 screws (87.5 % of 1,085 planned screws) were successfully implanted. Eleven screws (1.0 %) placed using the robotic system were misplaced (all presumably due to ''skiving'' of the drill bit or trocar off the side of the facet). Robotic guidance was aborted and 110 screws (10.1 %) were manually placed, generally due to poor registration and/or technical trajectory issues. Fifteen screws (1.4 %) were not placed after intraoperative determination that the screw was not essential for construct stability. The robot was not used as planned in seven patients, one due to severe deformity, one due to very high body mass index, one due to extremely poor bone quality, one due to registration difficulty caused by previously placed loosened hardware, one due to difficulty with platform mounting and two due to device technical issues. Conclusion Of the 960 screws that were implanted using the robot, 949 (98.9 %) were successfully and accurately implanted and 11 (1.1 %) were malpositioned, despite the fact that the majority of patients had significant spinal deformities and/or previous spine surgeries. ''Tool skiving'' was thought to be the inciting issue with the misplaced screws. Intraoperative anteroposterior and oblique fluoroscopic imaging for registration is critical and was the limiting issue in four of the seven aborted cases.

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“…In general, research in this area has focused on accurate placement of spinal instrumentation, citing the theoretically increased accuracy that robotics offers 13 . In radiosurgery, robotic solutions to spine motion with respiration have also been extremely useful 14 . As with intracranial radiosurgical applications, the most common robotic subtype in spinal stereotactic radiosurgery is the supervisory-controlled system.…”

mentioning

confidence: 99%