Next-Generation Robotic Spine Surgery: First Report on Feasibility, Safety, and Learning Curve

Abstract

Background Pedicle screw placement is a commonly performed procedure. Robot-guided screw placement is a recent technological advance that has shown accuracy and reliability with first-generation platforms. Objective To report our initial experience with the safety, feasibility, and learning curve associated with pedicle screw placement utilizing next-generation robotic guidance. Methods A retrospective chart review was conducted to obtain data for 20 patients who underwent lumbar pedicle screw placement under robotic guidance after undergoing interbody fusion for lumbar spinal stabilization for degenerative disc disease with or without spondylolisthesis. The newest generation Mazor X (Mazor Robotics Ltd, Caesarea, Israel) was used. Accuracy of screw placement was determined to be grade I to IV. Grade I was in the pedicle (no breach/deviation), grade II was breach < 2 mm, grade III was breach 2 to 4 mm, and grade IV was breach >4 mm; breach direction (superior, lateral, inferior, or medial) was also recorded. Results Twenty patients underwent robotically assisted pedicle screw placement of 75 screws at 24 levels. Seventy-four screw placements (98.7%) were grade I; 1 (1.3%) was grade II (medial). No complications occurred. Mean time for screw insertion was 3.6 min. Mean fluoroscopy time was 13.1 s and mean radiation dose was 29.9 mGy. CONCLUSION We found that next-generation robotic spine surgery was safe and feasible with reliable and precise accuracy and a minimal learning curve. As this technology improves, further novel applications are expected to develop. Further research is needed to determine long-term efficacy.

Surgeons' Learning Curve of Renaissance Robotic Surgical System

“…The learning curve, safety, and feasibility was investigated by Khan et al 18 The authors reported no screw misplacement and no complications within the first 20 patients using the robotic spine surgery system. The mean time for screw insertion was 3.6 minutes, and the authors 18 concluded that only a minimal learning curve exists.…”

“…Urakov et al 17 described improved efficiency with increased case load, but they also noted that the learning curve was largely dependent on the experience and the dedication of the operator. Khan et al, 18 however, described a minimal learning curve involved with robotic spine surgery and stated the efficacy of the technique. Most of the literature describing the learning curve using robotic surgery focused on pedicle screw insertion time but failed to report on the overall operative time, including cases in which the robotic system malfunctioned.…”

Initial Single-Institution Experience With a Novel Robotic-Navigation System for Thoracolumbar Pedicle Screw and Pelvic Screw Placement With 643 Screws

“…Similarly, a recent study examining the feasibility of another robotic-navigation guided system, Mazor X (Mazor Robotics Ltd) reported an accuracy rate of 98.7% examining 75 screws. 13 In addition to improving accuracy, while not directly examined in this study, importantly the robotic-navigation system has the added advantage of likely reducing radiation exposure intraoperatively to the both the patient and the surgeon. The only fluoroscopy required intraoperatively are the few images required for registration, including a good AP and lateral at each instrumented level.…”

Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

“…In addition, authors reported a favorable learning curve compared to older versions of the system. 32…”