Pedicle screw accuracy in clinical utilization of minimally invasive navigated robot-assisted spine surgery

Abstract

In the emerging field of robot-assisted spine surgery, the radiographic evaluation of pedicle screw accuracy in clinical application is an area of high interest. This study describes the pedicle screw accuracy of the first 56 consecutive cases in which navigated robotic assistance was used in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 56 navigated robot-assisted spine surgery cases was performed. Pedicle screw malposition, reposition, and return to operating room (OR) rates were collected. A CT-based Gertzbein and Robbins system (GRS) was used to classify pedicle screw accuracy. In the first 56 robotic cases, 356 total pedicle screws were placed. Eight screws were placed without the robot due to surgeon discretion. Of the 348 pedicle screws inserted by navigated robotic guidance, only 2.6% (9/348) were repositioned, resulting in a 97.4% (339/348) successful screw placement rate. The average age was 64, and 48% were female. Average body mass index was 31 kg/m 2 . Based on the GRS CT-based grading, 97.7% (340/348) were graded A or B, 1.7% (6/348) screws were graded C, and only 0.6% (2/348) of screws were graded D. Two complications, explantation of interbody and vacuum-assisted wound closure, were reported as requiring a return to the OR, but these were not related to robotic guidance or pedicle screws. This study demonstrated a high level of accuracy (97.7%) in the first 56 cases using navigated, robot-assisted surgery based on the GRS. There were two non-screw-related complications requiring return to the operating room.

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

“…However, some studies have shown that pedicle screw placement using navigation systems with robotics has no advantage in terms of accuracy; therefore, there is still controversy in terms of accuracy and safety 18,19 . On the other hand, the general evaluation is that the accuracy and safety of pedicle screw placement using navigation systems with robotics are superior to that of conventional or freehand techniques 20–25 . Even if the superiority and safety of the navigation and robotic systems using intraoperative O‐arm‐based images or CT images are secured, in view of the cost aspect, with O‐arms being expensive, and the current status of dissemination, if the navigation system using the C‐arm already owned by hospitals is available, it is thought that more hospitals will be able to apply efficient and reliable surgical methods at a low cost.…”

“…18,19 On the other hand, the general evaluation is that the accuracy and safety of pedicle screw placement using navigation systems with robotics are superior to that of conventional or freehand techniques. [20][21][22][23][24][25] Even if the superiority and safety of the navigation and robotic systems using reported that breached pedicles were observed in 37 of the 161 screws, of which 31 were breaching less than 2 mm (clinically acceptable) when performed using a navigation system with a preoperative C-arm image in 41 consecutive patients. 26 Most studies evaluated the accuracy of screw insertion using the GRS grade, but when we evaluated the accuracy of screw insertion using GRS grade in our preclinical animal study, it might seem that our insertions were less accurate than in other studies conducted on human patients.…”

Evaluation of a new spinal surgical robotic system of Kirschner wire placement for lumbar fusion: A multi‐centre, randomised controlled clinical study

“…As reported in previous studies, the accuracy of the robot assistant system varies from 85% to 100% 33–38 . Vardiman et al 39 . compared the accuracy of free‐hand and robot‐assisted screw placement, and they found that the accuracy in the RG was 98.67% to 97.67%, which was significantly better than that in the FG.…”

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

“…According Gertzbein and Robbins classification system based on CT imaging, they found that 98.3% were graded A (screw completely in the pedicle) or B (breach < 2 mm), 1.0% screws were graded C (breach < 4 mm), and only 0.7% screws were graded D (breach < 6 mm). In a similar study from Vardiman et al, 39 348 screws placed with navigated robotic assistance resulted in a high level of accuracy (97.7% grades A and B).…”