Lateral versus prone robot-assisted percutaneous pedicle screw placement: a CT-based comparative assessment of accuracy

Abstract

OBJECTIVE Single-position lateral lumbar interbody fusion (SP-LLIF) has recently gained significant popularity due to increased operative efficiency, but it remains technically challenging. Robot-assisted percutaneous pedicle screw (RA-PPS) placement can facilitate screw placement in the lateral position. The authors have reported their initial experience with SP-LLIF with RA-PPS placement in the lateral position, and they have compared this accuracy with that of RA-PPS placement in the prone position. METHODS The authors reviewed prospectively collected data from their first 100 lateral-position RA-PPSs. The authors graded screw accuracy on CT and compared it to the accuracy of all prone-position RA-PPS procedures during the same time period. The authors analyzed the effect of several demographic and perioperative metrics, as a whole and specifically for lateral-position RA-PPS placement. RESULTS The authors placed 99 lateral-position RA-PPSs by using the ExcelsiusGPS robotic platform in the first 18 consecutive patients who underwent SP-LLIF with postoperative CT imaging; these patients were compared with 346 prone-position RA-PPSs that were placed in the first consecutive 64 patients during the same time period. All screws were placed at L1 to S1. Overall, the lateral group had 14 breaches (14.1%) and the prone group had 25 breaches (7.2%) (p = 0.032). The lateral group had 5 breaches (5.1%) greater than 2 mm (grade C or worse), and the prone group had 4 (1.2%) (p = 0.015). The operative level had an effect on the breach rate, with breach rates (grade C or worse) of 7.1% at L3 and 2.8% at L4. Most breaches were grade B (< 2 mm) and lateral, and no breach had clinical sequelae or required revision. Within the lateral group, multivariate regression analysis demonstrated that BMI and number of levels affected accuracy, but the side that was positioned up or down did not. CONCLUSIONS RA-PPSs can improve the feasibility of SP-LLIF. Spine surgeons should be cautious and selective with this technique owing to decreased accuracy in the lateral position, particularly in obese patients. Further studies should compare SP-LLIF techniques performed while the patient is in the prone and lateral positions.

Assessing Procedural Accuracy in Lateral Spine Surgery: A Retrospective Analysis of Percutaneous Pedicle Screw Placement with Intraoperative CT Navigation

“…Moreover, emerging innovations, like robotic spinal surgery and the growing popularity of LLIF, emphasize the potential of PPS insertion in the lateral decubitus position [27][28][29]. The LLIF approach is versatile and suitable for various degenerative conditions.…”

Analysis of the Screw Accuracy and Postoperative Efficacy of Screw Placement in Single Position and Bipedal Position in Robot‐Assisted Oblique Lumbar Interbody Fusion: Preliminary Results of Mazor X Stealth Usage

“…However, current studies differ in terms of whether changes in position have an effect on screw accuracy, and in an analysis of the accuracy of 453 screws in 78 patients who received lateral placement in the prone position by Okuda, Ryuichiro et al showed no statistically significant conceptual difference from the prone group 19 . A meta‐analysis by Keorochana et al showed no statistically significant difference between the lateral and prone positions in terms of intraoperative blood loss, radiotherapy dose, lumbar lordosis, incidence of complications, or need for reoperation, 20 while a study by Fayed et al showed that lateral position nailing had a higher error rate 21 . In addition, most studies used only postoperative CT as a criterion for the presence and extent of bias.…”

“…showed no statistically significant difference between the lateral and prone positions in terms of intraoperative blood loss, radiotherapy dose, lumbar lordosis, incidence of complications, or need for reoperation, 20 while a study by Fayed et al showed that lateral position nailing had a higher error rate. 21 In addition, most studies used only postoperative CT as a criterion for the presence and extent of bias. In clinical practice, for intraoperative misaligned K-wires, the surgeon may choose to realign or change to freehand placement.…”

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

“…The orthopedic surgical robot has the advantages of safety, accuracy, less radiation, and a shorter learning curve, and more and more surgeons have begun to perform robot-assisted surgeries [ 17 ]. In spinal surgeries, robot assistance is often adopted for pedicle screw insertion, navigation, and positioning in vertebroplasty [ 18 , 19 , 20 , 21 , 22 ]. Therefore, the accuracy of robot navigation and positioning directly affects the quality of spinal surgeries.…”