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

Abstract

Background We assessed pedicle screw accuracy utilizing a novel navigation‐based spine surgery robotic system by comparing planned pathways with placed pathways in a porcine model. Methods We placed three mini screws per vertebra for accuracy evaluation and used a reference frame for registration in four pigs (46 screws in 23 vertebrae). We planned screw paths and performed screw insertion under robot guidance. Using C‐arm and CT images, we evaluated accuracy by comparing the 3D distance of the placed screw head/tip from the planned screw head/tip and 3D angular offset. Results Mean registration deviation between the preoperative 3D space (C‐arm) and postoperative CT scans was 0.475 ± 0.119 mm. The average offset from preoperative plan to final placement was 4.8 ± 2.0 mm from the head (tail), 5.3 ± 2.3 mm from the tip and 3.9 ± 2.4 degrees of angulation. Conclusions Our spine surgery robot showed good accuracy in executing an intended planned trajectory and screw path. This faster and more accurate robotic system will be applied in future studies, first in cadavers and subsequently in the clinical field.

Novel C‐arm‐based planning robotic spinal surgery in a cadaver model using quantitative accuracy assessment methodology

“…robotic-assisted pedicle screw placement with intraoperative 3D image-based planning, our method using C-arm-based images yielded similar results. 20,24,25,28,29 Furthermore, the mean values for each offset type were 1.78 mm, 2.3 mm, and 2.64°, respectively, which are comparable or superior to those reported by other studies. [30][31][32] In the case of the patient as well as the cadaver, when screws were inserted there was the force of which surroundings such as muscle and skin push the instruments and screws.…”

“…Although a prior study used intraoperative C‐arm‐assisted robot screw placement in a porcine model, clinical trial results have not been reported. However, compared with the clinical trial results of robotic‐assisted pedicle screw placement with intraoperative 3D image‐based planning, our method using C‐arm‐based images yielded similar results 20,24,25,28,29 . Furthermore, the mean values for each offset type were 1.78 mm, 2.3 mm, and 2.64°, respectively, which are comparable or superior to those reported by other studies 30–32 …”

“…The CUVIS-spine (Curexo Inc., Republic of Korea; Figure 1 and Table 1) is a robotic surgical system with an image-guided navigation system. 20 This system allows the insertion of surgical instruments or screws along the planned insertion path generated by a surgeon using intraoperatively scanned 2D images or 3D volumes. In this study, AP and LL images obtained using 2D digital spot C-arm fluoroscopy were used.…”

Association of robot-assisted techniques with the accuracy rates of pedicle screw placement: A network pooling analysis

“… 55 Finally, Curexo® is a robot-assisted spine surgery system that uses a C-arm-based navigation system. 52 Kim et al. reported that accuracy rates for pedicle screws placement were less accurate than in other studies on human patients (Grades A+B: 80.4%), 52 which may be attributed to the fact that the robot is still at a developmental stage.…”

“…Several robotic systems like CIRQ® (Brainlab Germany), 49 Excelsius GPS® (Globus Medical), 50 Mazor X (Mazor Robotics Ltd., Caesarea, Israel), 51 and Curexo® (Curvis-spine, South Korea) 52 were not included in our study due to no suitable controlled studies. It has been reported that the lightweight and table-mounted aspects of the new CIRQ® arm are intended to be more ergonomic and less disruptive to operative workflow relative to larger robotic units.…”