Letter: Image-Guided Navigation and Robotics in Spine Surgery

Scalia, Gianluca; Umana, Giuseppe Emmanuele; Graziano, Francesca; Tomasi, Santino Ottavio; Furnari, Massimo; Giuffrida, Massimiliano; Ponzo, Giancarlo; Nicoletti, Giovanni Federico

doi:10.1093/neuros/nyaa404

Cited by 18 publications

(3 citation statements)

References 3 publications

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“…The role of robotics is to automate complex procedural tasks that are usually subject to potential human errors, even in experienced surgeons. [ 21 22 23 ] In this study, we found that the robotic-assisted procedure could offer several advantages compared to the freehand procedure, including improved positioning of the insertion probe, reduced procedure time, decreased blood loss, and reduced radiation exposure.…”

Section: Discussionmentioning

confidence: 90%

Enhancing palliative care in vulnerable patients: Robot-assisted radiofrequency ablation for multiple spinal metastases – Technical insights and preliminary outcomes

Ricciardo,

Garufi,

Scalia

et al. 2024

Journal of Craniovertebral Junction and Spine

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Background: Radiofrequency thermal ablation (RFA) coupled with vertebroplasty or kyphoplasty offers a minimally invasive, safe, and efficacious approach to palliate polymetastatic spine disease, particularly in medically fragile individuals. However, the application of robotic assistance to RFA for spinal metastases remains unexplored. This study elucidates the technical viability of robot-assisted RFA combined with vertebroplasty in patients afflicted by multiple spinal metastases and presents preliminary outcomes. An illustrative case was also presented. Materials and Methods: Ten patients aged over 65 years with multiple vertebral metastases were enrolled in this study. Preoperatively, patients exhibited a median Visual Analog Scale (VAS) pain score of 6 and a Median Oswestry Disability Index (ODI) score of 58%. From February 2021 to April 2022, all patients underwent RFA, followed by vertebroplasty for spinal metastases. Surgical procedures were executed using the ExcelsiusGPS® robotic platform. Results: Patients experienced substantial pain relief, with a median VAS score of 2.5 at 24 h postoperatively (Δ −−3.5; P < 0.001) and a median VAS score of 2 at 1 month postoperatively (Δ −4; P < 0.001). All patients were discharged on the first postoperative day and continued their oncological treatments. In addition, the median ODI score at 1 month postoperatively was 34% (Δ −−24%; P = 0.006), indicating an enhanced quality of life and a satisfactory impact on daily activities. No procedural or postoperative complications were documented. Conclusions: This case series represents the inaugural successful application of robot-assisted RFA in conjunction with concurrent vertebroplasty/kyphoplasty. Our preliminary experience demonstrates that patients with oligo- and polymetastatic conditions can derive benefits from this minimally invasive intervention, characterized by rapid postoperative recovery and effective short- to medium-term pain management, without encountering complications.

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Section: Discussionmentioning

confidence: 90%

Enhancing palliative care in vulnerable patients: Robot-assisted radiofrequency ablation for multiple spinal metastases – Technical insights and preliminary outcomes

Ricciardo,

Garufi,

Scalia

et al. 2024

Journal of Craniovertebral Junction and Spine

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“…Moreover, as a result of training, inexperienced doctors are more likely to perform the procedure with higher accuracy and less operation time (Siddiqui et al 2019, Morse et al 2021, Yu et al 2021. However, the current commercial robotic surgery systems usually lack automation as the doctors must manually plan the direction and position of the screw track on the preoperative or intraoperative images before operation (Kochanski et al 2019, Scalia et al 2020.…”

Section: Introductionmentioning

confidence: 99%

Improving pedicle screw path planning by vertebral posture estimation

et al. 2023

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Objective: Robot-assisted pedicle screw placement in spine surgery can reduce the complications associated with the screw placement and reduce the hospital return counts due to malfunctions. However, it requires accurate planning for high quality procedures. The state-of-the-art technologies reported in the literature either ignore the anatomical variations across vertebrae or require substantial human interactions. We present an improved approach that achieves the pedicle screw path planning through multiple projections of a numerically re-oriented vertebra with the estimated posture.Approach: We proposed an improved YOLO-type neural network model (YOLOPOSE3D) to estimate the posture of a vertebra before the pedicle path planning. In YOLOPOSE3D, the vertebral posture is given as a rotation quaternion and 3D location coordinates by optimizing the intersection over union (IoU) of the vertebra with the predicted posture and the actual posture. Then, a new local coordinate system is established for the vertebra based on the estimated posture. Finally, the optimal pedicle screw path trajectory is determined from the multiple projections of the vertebra in the local coordinates. Main results:The experimental results in difficult cases of scoliosis showed that the new YOLOPOSE3D network could detect the location and posture of the vertebra accurately with average translation and orientation errors as small as 1.55 mm and 2.55. The screw path planning achieved 83.1% success rate without breaking the pedicle cortex for the lumbar vertebral L1-L5, which is better than that of doctor’s manual planning, 82.4%. With the clinical class A requirement of allowing less than 2mm out of the pedicle cortex, the success rate achieved nearly 100%. Significance: The proposed YOLOPOSED3D method can accurately determine the vertebral postures. With the improved posture prior, better clinical outcomes can be achieved for pedicle screw placement in spine internal fixation procedures. 

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“…[2][3][4] Intraoperative imaging devices such intraoperative computed tomography, O-ARM, Ziehm rfd, and Loop-X allow to verify the accuracy during the entire time of the procedure making misplacement impossible since the trajectory can be modified until getting the desired result, thus avoiding redo surgery with its high medicolegal risks. [5][6][7][8][9][10][11] Moving toward the cranial direction, also approaches to the craniovertebral junction are performed reducing of surgical damage to soft tissues; the use of endonasal approaches to C1-C2 has decreased morbidity and the odontoid screw fixation has been reported to be performed percutaneously. [12][13][14] Furthermore, vertebral corpectomy, invasive as well all know, can be accomplished with MIS technique for both traumatic and tumoral diseases, reducing surgical blood loss, patient's morbidity, and hospital stay saving costs.…”

mentioning

confidence: 99%