Navigated robotic assistance improves pedicle screw accuracy in minimally invasive surgery of the lumbosacral spine: 600 pedicle screws in a single institution

Wallace, David J.; Vardiman, Arnold B.; Booher, Grant; Crawford, Neil R.; Riggleman, Jessica R.; Greeley, Samantha; Ledonio, Charles Gerald T.

doi:10.1002/rcs.2054

Cited by 39 publications

(40 citation statements)

References 15 publications

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“…To increase the accuracy of screw insertion, computer navigation-assisted surgery, and 3DPM are used in spinal surgery. [ 1 , 2 , 6 , 18 , 20 , 21 , 27 , 28 ] Sakai Y et al [ 22 ] described that the navigation-assisted surgery is more accurate than freehand pedicle screw insertion, but it still has an 11.4% incidence of pedicle puncture. Yang et al [ 20 ] suggested that the 3DPM can help surgeons to observe the anatomical structure of the lesion and simulate the operation before surgery; however, there is still a rate of 16.9% pedicle penetration.…”

Section: Discussionmentioning

confidence: 99%

“…Varieties techniques have been developed to promote pedicle screw insertion, including computer-aided surgery, [ 1 , 16 – 18 ] guiding devices surgery, [ 19 ] 3-dimensional rapid prototyping technology, [ 20 , 21 ] robot-assisted operation, [ 2 ] and augmented reality navigation surgery. [ 3 ] However, these methods still have 1.8% to 11.4% screw malposition rate.…”

Section: Introductionmentioning

confidence: 99%

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Combined 3-dimensional printing model and 3-dimensional fluoroscopic navigation to assist C2 pedicle screw insertion

Zheng²,

Dong³

et al. 2020

Medicine

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Rationale: The misplaced cervical screw can cause catastrophic surgical complications, such as nerve root damage, vertebral artery compromise, spinal cord injury, and even paraplegia. Thus, the present study aims to describe a novel technique of 3-dimensional printing model (3DPM) combined with 3-dimensional fluoroscopic navigation (3DFN) to facilitate C2 pedicle screw insertion. Patient concerns: A 56-year-old male patient presented hypoesthesia of the trunk and extremities, accompanied by a walking disorder. Diagnoses: Congenital atlantoaxial malformation with atlantoaxial dislocation. Interventions: He underwent an occipital cervical fusion. We used 3DPM and 3DFN technology to guide C2 pedicle screws insertion. Outcomes: We inserted 2 pedicle screws and 4 lateral mass screws using the combined 3DPM and 3DFN technology. All screws were classified as excellent position postoperatively. The surgical duration, total fluoroscopic time, and the bleeding volume were 258 minutes, 3.9 minutes, and 237 mL, respectively. No surgical complications, such as neurological compromise, nonunion, dysphagia, infection, polypnea, fixation failure, pseudarthrosis formation, or revision surgery, were observed. The follow-up duration lasted 30 months. Lessons: The combination of 3DPM and 3DFN to promote C2 pedicle screws implantation is a safe, accurate, reliable, and useful technology, which can achieve an excellent therapeutic effect and avoid surgical complications. However, using the 3DPM and 3DFN technology may increase the financial burden of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined 3-dimensional printing model and 3-dimensional fluoroscopic navigation to assist C2 pedicle screw insertion

Zheng²,

Dong³

et al. 2020

Medicine

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“…The Rosa and TIRobot systems optically track and facilitate real-time end effector compensation for patient movement during respiration and surgical manipulation (27)(28)(29)31,35). The Excelsius GPS also employs additional unique features to ensure navigation integrity (30,36). To address unintentional DRB shift, which can go unnoticed and result in screw mal-positioning, an additional optical array with just one reflective marker ball is placed into the contralateral PSIS.…”

Section: Analysis Of Platform Nuances and Featuresmentioning

confidence: 99%

The current state of navigation in robotic spine surgery

Huang¹,

Tetreault²,

Vaishnav³

et al. 2021

Ann Transl Med

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The advent and widespread adoption of pedicle screw instrumentation prompted the need for image guidance in spine surgery to improve accuracy and safety. Although the conventional method, fluoroscopy, is readily available and inexpensive, concerns regarding radiation exposure and the drive to provide better visual guidance spurred the development of computer-assisted navigation.Contemporaneously, a non-navigated robotic guidance platform was also introduced as a competing modality for pedicle screw placement. Although the robot could provide high precision trajectory guidance by restricting four of the six degrees of freedom (DOF), the lack of real-time depth control and high capital acquisition cost diminished its popularity, while computer-assisted navigation platforms became increasingly sophisticated and accepted. The recent integration of real-time 3D navigation with robotic platforms has resulted in a resurgence of interest in robotics in spine surgery with the recent introduction of numerous navigated robotic platforms. The currently available navigated robotic spine surgery platforms include the

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“…In recent years, with the vigorous development of spinal endoscopy, the conventional open spinal surgery has been gradually replaced by minimally invasive surgery, and percutaneous xation and fusion has been a trend 1,2 . The accurate positioning of the pedicle is crucial in both conventional open approach and minimally invasive spinal surgery 3 . The angle of the pedicle can change due to the extroversion angle of the pedicle, the head or tail tilting, and even possible lateral curvature and rotation caused by serious degeneration, which may lead to di culties in the accuracy of pedicle screw placement.…”

Section: Introductionmentioning

confidence: 99%

“…Many of the problems in spinal surgery occur in the process of pedicle screw misplacement 5 . Nowadays the accuracy of pedicle screw placement can be obtained with navigated robotic assistance 2,3 . But the navigated robotic assistance is too expensive to be widely used so far.…”

Section: Introductionmentioning

confidence: 99%

Application of a new percutaneous multi-function pedicle locator in minimally invasive spine surgery

Liu

Wang

2021

Preprint

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A new percutaneous multi-function pedicle locator was designed to be used for personalized three-dimensional positioning of a pedicle in minimally invasive spine surgery without computer-assisted navigation technology. This article instructed the method and advantages of using a new percutaneous multi-function pedicle locator in minimally invasive surgery of the spine. Based on the position of a pedicles suggested by CT and X-ray images of a patient, 6 lines and 2 distances were used to determine the puncture point of a pedicle screw, while 2 angles were used to determine the inserting direction of a pedicle guide needle from the patient's body surface. The result of application of the locator was roughly compared with that of the conventional freehand technique. The potential benefits of using the locator included enhancing surgical accuracy, reducing the operation time, mitigating the harmful intra-operative radiation exposure, saving the costs and shortening the learning curve of young orthopedists. It was hoped that more doctors and patients will benefit from it.

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Navigated robotic assistance improves pedicle screw accuracy in minimally invasive surgery of the lumbosacral spine: 600 pedicle screws in a single institution

Cited by 39 publications

References 15 publications

Combined 3-dimensional printing model and 3-dimensional fluoroscopic navigation to assist C2 pedicle screw insertion

Combined 3-dimensional printing model and 3-dimensional fluoroscopic navigation to assist C2 pedicle screw insertion

The current state of navigation in robotic spine surgery

Application of a new percutaneous multi-function pedicle locator in minimally invasive spine surgery

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