Does the accuracy of pedicle screw placement differ between the attending surgeon and resident in navigated robotic-assisted minimally invasive spine surgery?

Abstract

Robotic assistance with integrated navigation is an area of high interest for improving the accuracy of minimally invasive pedicle screw placement. This study analyzes the accuracy of pedicle screw placement between an attending spine surgeon and a resident by comparing the left and right sides of the first 101 consecutive cases using navigated robotic assistance in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed. One attending spine surgeon and one resident performed pedicle screw placement consistently on either the left or right side (researchers were blinded). A CT-based Gertzbein and Robbins system (GRS) was used to classify pedicle screw accuracy, with grade A or B considered accurate. There were 630 consecutive lumbosacral pedicle screws placed. Thirty screws (5 patients) were placed without the robot due to surgeon discretion. Of the 600 pedicle screws inserted by navigated robotic guidance (101 patients), only 1.5% (9/600) were repositioned intraoperatively. Based on the GRS CT-based grading of pedicle breach, 98.67% (296/300) of left-side screws were graded A or B, 1.3% (4/300) were graded C, and 0% (0/300) were graded D. For the right-side screws, 97.67% (293/300) were graded A or B, 1.67% (5/300) were graded C, and 0.66% (2/300) were graded D. This study demonstrated a high level of accuracy (based on GRS) with no significant differences between the left- and right-side pedicle screw placements (98.67% vs. 97.67%, respectively) in the clinical use of navigated, robot-assisted surgery.

Novel C‐arm based planning spine surgery robot proved in a porcine model and quantitative accuracy assessment methodology

“…After the operation, postoperative CT images were used for accuracy assessment of pedicle screw placement. In previous studies, the Gertzbein–Robbins classification system (GRS) grade was used to evaluate the accuracy of pedicle screw placement 10–13 . However, in this study, it was difficult to evaluate accuracy based on the same criteria in an animal experiment using the porcine model due to the difference in spine structure between humans and pigs.…”

“…In previous studies, the Gertzbein-Robbins classification system (GRS) grade was used to evaluate the accuracy of pedicle screw placement. [10][11][12][13] However, in this study, it was difficult to evaluate accuracy based on the same criteria in an animal experiment using the porcine model due to the difference in spine structure between humans and pigs. In addition, the GRS is not quantitative; however, it consists of clinical and radiological analyses and has limitations that made it difficult to compare between different experiments using this data.…”

Workflow and Efficiency of Robotic-Assisted Navigation in Spine Surgery

“…Intraoperative CT scans can be obtained from a portable scanner such as an O-arm or a standard CT scanner at the time of surgery with the patient in the prone position [15]. After a CT scan is taken, the spinal levels are identified based on pedicle screw trajectories that were already planned and saved.…”

Robotic spine surgery: Ushering in a new era

“…In a retrospective study comparing the accuracy of pedicle screw placement by an attending surgeon and an orthopaedic resident using a robot, the authors reported no significant difference in either the accuracy or the average offset of the actual final placement of screws to the preoperatively planned trajectory. 28 The use of robotic assistance may allow aging surgeons to execute their surgical plan with the same level of physical and cognitive performance as young surgeons in their prime years. 29…”

“…Pedicle screw insertion Use supported by few Level-1 studies and large number of retrospective studies RA pedicle screw placement improves accuracy of intrapedicular screw placement, 24,25 reduces incidence of cranial facet violation, 24,26 has reproducible consistency, 28 reduces radiation exposure, 30,31 increases operative time 30,32 which include its cost, accessibility and quality. Since there is no reliable data on the long term outcomes of robotic spine surgery e particularly, about how it compares to conventional techniques e a true measure of the value it adds to the healthcare system is difficult to gauge.…”