Comparing Cortical Bone Trajectories for Pedicle Screw Insertion using Robotic Guidance and Three-Dimensional Computed Tomography Navigation

Khan, Asham; Rho, Kyungduk; Mao, Jennifer; O’Connor, Timothy E.; Agyei, Justice O.; Meyers, J.; Mullin, Jeffrey P.; Pollina, John

doi:10.1016/j.wneu.2020.05.257

Cited by 29 publications

(39 citation statements)

References 39 publications

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“…On full-text review, 76 articles were excluded, most commonly because they did not present learning curve data (n = 62) or did not present primary data (n = 7). This left 21 articles 9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29][30][31][32] that met inclusion and exclusion criteria (Table 2). All were case series (level IV evidence) at high risk of reporting bias.…”

Section: Resultsmentioning

confidence: 99%

“…All were case series (level IV evidence) at high risk of reporting bias. Of the included articles, 2 described experiences with the Mazor SpineAssist, 19,27 8 with the Mazor Renaissance, 12,18, 20-22, 24, 28,32 5 with the Mazor X, 14,16,25,29,31 2 with the Mazor X Stealth, 13,17 3 with the ExcelsiusGPS, 9,23,30 and 1 with the TiRobot. 15 Fourteen series described the experience of a single attending surgeon, 9,12, 13, 15-18, 20, 21, 24, 25, 29, 31,32 5 described the pooled experience of multiple attending surgeons, 14,19,27,28,30 1 described the experiences of supervised residents or spine fellows, 22 and 1 described the experiences of a single attending surgeon and two spine fellows.…”

Section: Resultsmentioning

confidence: 99%

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Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula

Pennington

Judy

Zakaria

et al. 2022

Neurosurgical Focus

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OBJECTIVE Spine robots have seen increased utilization over the past half decade with the introduction of multiple new systems. Market research expects this expansion to continue over the next half decade at an annual rate of 20%. However, because of the novelty of these devices, there is limited literature on their learning curves and how they should be integrated into residency curricula. With the present review, the authors aimed to address these two points. METHODS A systematic review of the published English-language literature on PubMed, Ovid, Scopus, and Web of Science was conducted to identify studies describing the learning curve in spine robotics. Included articles described clinical results in patients using one of the following endpoints: operative time, screw placement time, fluoroscopy usage, and instrumentation accuracy. Systems examined included the Mazor series, the ExcelsiusGPS, and the TiRobot. Learning curves were reported in a qualitative synthesis, given as the mean improvement in the endpoint per case performed or screw placed where possible. All studies were level IV case series with a high risk of reporting bias. RESULTS Of 1579 unique articles, 97 underwent full-text review and 21 met the inclusion and exclusion criteria; 62 articles were excluded for not presenting primary data for one of the above-described endpoints. Of the 21 articles, 18 noted the presence of a learning curve in spine robots, which ranged from 3 to 30 cases or 15 to 62 screws. Only 12 articles performed regressions of one of the endpoints (most commonly operative time) as a function of screws placed or cases performed. Among these, increasing experience was associated with a 0.24- to 4.6-minute decrease in operative time per case performed. All but one series described the experience of attending surgeons, not residents. CONCLUSIONS Most studies of learning curves with spine robots have found them to be present, with the most common threshold being 20 to 30 cases performed. Unfortunately, all available evidence is level IV data, limited to case series. Given the ability of residency to allow trainees to safely perform these cases under the supervision of experienced senior surgeons, it is argued that a curriculum should be developed for senior-level residents specializing in spine comprising a minimum of 30 performed cases.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula

Pennington

Judy

Zakaria

et al. 2022

Neurosurgical Focus

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“…Furthermore, robot-assisted surgeries are becoming alternatives to traditional surgical navigation and trajectory planning using intraoperative CT or fluoroscopy. Furthermore, a retrospective study by Khan et al, which compared 22 patients who underwent robot-assisted CBT to 18 patients who underwent CT-navigated CBT, found better accuracy (100%) for robot-guided CBTs 55 . While this study was limited due to its small sample size that curtails the generalizability of its findings, it represents the beginning of a new era of history for CBT and pedicle screw fixation in general, where one may raise the question of how much further these techniques can be enhanced in terms of safety and efficacy through the aid of robotics and machine learning.…”

Section: Evolution Of Technique and Directions For The Futurementioning

confidence: 99%

Historical Note: The Evolution of Cortical Bone Trajectory and Associated Techniques

Kim¹,

Mobbs²,

Natarajan³

et al. 2022

Spine Surg Relat Res

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was the principal author, responsible for conducting the literature review and writing the primary manuscript. R.J. Mobbs provided the direction for the paper, provided a clinical background to CBT and the figures displayed in this manuscript, and revised the first manuscript. P. Natarajan and R.D. Fonseka assisted with data/literature collection and provided revisions of the final manuscript. W.R. Walsh provided biomechanical background to the CBT to the primary author and reviewed the final manuscript. Ethics ApprovalNo ethics approval was not required as this was a historical review paper and did not require (1) biomechanical testing using cadaveric/animal specimen or (2) any clinical participants.

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Section: Introductionmentioning

confidence: 99%

“…Techniques that have been used to successfully guide screw placement include endoscopy, three-dimensional computed tomography (CT), and fluoroscopy [7,8]. All three have shown good accuracy with minimal complications [9,10]. Rodriguez et al demonstrated good clinical results in a cohort of patients who underwent a novel fusion technique that uses CBT fixation in a previously instrumented pedicle with intraoperative O-arm guided navigation [11].…”

Section: Introduction Background and Importancementioning

confidence: 99%

Minimally Invasive Robot-Guided Dual Cortical Bone Trajectory for Adjacent Segment Disease

Rho¹,

O’Connor²,

Lucas³

et al. 2021

Cureus

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Here we present a novel application of cortical bone trajectory (CBT) fixation utilizing robotic guidance in a previously instrumented spine with a traditional pedicle screw (PS), obviating the need for a larger posterior incision, reducing the risk of infection, muscular dissection, and likely decreasing hospital length of stay. A 60-year-old woman with prior left L3-L4 extreme lateral interbody fusion and unilateral percutaneous PS placed at L3 to L5 presented with progressive bilateral lower-extremity pain and diminished sensation in the S1 dermatome secondary to adjacent segment disease (ASD). The patient underwent an L5-S1 anterior lumbar interbody fusion for indirect decompression and restoration of segmental lordosis. After the first stage was completed, she was turned prone for posterior percutaneous instrumentation. Given prior instrumentation at L3-L5 on the left side, a robot planning software was used to plan a cortical bone screw on the left L5 pedicle. A left S1 PS was then planned with the screw head aligning with the left L5 cortical bone screw. Instrumentation was then placed percutaneously using the robot bilaterally without issue. Intraoperative fluoroscopic imaging demonstrated accurate placement of PS, and postoperative computed tomography demonstrated the excellent positioning of all PSs. This report is the first documented case of a robotically placed CBT screw placed in the same pedicle as a prior traditional PS for ASD. This method expands the surgical options for ASD to include robotic percutaneous placement of posterior instrumentation at the same level as previous instrumentation.

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Comparing Cortical Bone Trajectories for Pedicle Screw Insertion using Robotic Guidance and Three-Dimensional Computed Tomography Navigation

Cited by 29 publications

References 39 publications

Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula

Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula

Historical Note: The Evolution of Cortical Bone Trajectory and Associated Techniques

Minimally Invasive Robot-Guided Dual Cortical Bone Trajectory for Adjacent Segment Disease

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