Reduction in complication and revision rates for robotic-guided short-segment lumbar fusion surgery: results of a prospective, multi-center study

Liounakos, Jason I.; Kumar, Vignessh; Jamshidi, Aria; Silman, Zmira; Good, Christopher R.; Schroerlucke, Samuel R.; Cannestra, Andrew F.; Hsu, Victor; Lim, Jae Yol; Zahrawi, Faissal; Ramirez, Pedro M.; Sweeney, Thomas M.; Wang, Michael Y.

doi:10.1007/s11701-020-01165-5

Cited by 13 publications

(8 citation statements)

References 34 publications

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“…A recent meta-analysis on 39,387 patients who underwent posterior lumbar fusion revealed that robotic-assisted fusion had similar rates of surgical and medical complications compared with those who underwent conventional fusion [67]. In contrast to this finding, Liounakos et al, in their single center evaluation of 374 robotic-guided and 111 fluoroscopy guided procedures, reported that robotic guidance was associated with significant reductions in postoperative complication rates at all follow-up time points and significant reductions in revision rates at 90 days and 1 year [68].…”

Section: Comparison Of Robotic-guided Spine Surgery With Fluoroscopy-guided and Navigation-guided Spine Surgerymentioning

confidence: 97%

Initial Intraoperative Experience with Robotic-Assisted Pedicle Screw Placement with Cirq® Robotic Alignment: An Evaluation of the First 70 Screws

Pojskić

Bopp

Nimsky

et al. 2021

JCM

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Background: Robot-guided spine surgery is based on a preoperatively planned trajectory that is reproduced in the operating room by the robotic device. This study presents our initial experience with thoracolumbar pedicle screw placement using Brainlab’s Cirq® surgeon-controlled robotic arm (BrainLab, Munich, Germany). Methods: All patients who underwent robotic-assisted implantation of pedicle screws in the thoracolumbar spine were included in the study. Our workflow, consisting of preoperative imagining, screw planning, intraoperative imaging with automatic registration, fusion of the preoperative and intraoperative imaging with a review of the preplanned screw trajectories, robotic-assisted insertion of K-wires, followed by a fluoroscopy-assisted insertion of pedicle screws and control iCT scan, is described. Results: A total of 12 patients (5 male and 7 females, mean age 67.4 years) underwent 13 surgeries using the Cirq® Robotic Alignment Module for thoracolumbar pedicle screw implantation. Spondylodiscitis, metastases, osteoporotic fracture, and spinal canal stenosis were detected. A total of 70 screws were implanted. The mean time per screw was 08:27 ± 06:54 min. The mean time per screw for the first 7 surgeries (first 36 screws) was 16:03 ± 09:32 min and for the latter 6 surgeries (34 screws) the mean time per screw was 04:35 ± 02:11 min (p < 0.05). Mean entry point deviation was 1.9 ± 1.23 mm, mean deviation from the tip of the screw was 2.61 ± 1.6 mm and mean angular deviation was 3.5° ± 2°. For screw-placement accuracy we used the CT-based Gertzbein and Robbins System (GRS). Of the total screws, 65 screws were GRS A screws (92.85%), one screw was a GRS B screw, and two further screws were grade C. Two screws were D screws (2.85%) and underwent intraoperative revision. There were no perioperative deficits. Conclusion: Brainlab’s Cirq® Robotic Alignment surgeon-controlled robotic arm is a safe and beneficial method for accurate thoracolumbar pedicle screw placement with high accuracy.

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Section: Comparison Of Robotic-guided Spine Surgery With Fluoroscopy-guided and Navigation-guided Spine Surgerymentioning

confidence: 97%

Initial Intraoperative Experience with Robotic-Assisted Pedicle Screw Placement with Cirq® Robotic Alignment: An Evaluation of the First 70 Screws

Pojskić

Bopp

Nimsky

et al. 2021

JCM

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“…They found patients in the FG arm were 5.8 times more likely to develop a complication (HR=5.8, 95% CI: 3.5-9.6, p<0.001), and 11.0 times more likely to require a revision surgery (HR=11.0, 95% CI 2.9-41.2, p<0.001) compared to those in the RG [8]. Liounakos et al [18] found reduced complications and revisions in patients undergoing robotic-guided fusions. They reported an 8.02% 90-day complication rate with short segment robotic-guided fusions and 83.2% reduction in complications compared to freehand technique (p<0.001) [18].…”

Section: Discussionmentioning

confidence: 98%

“…Liounakos et al [18] found reduced complications and revisions in patients undergoing robotic-guided fusions. They reported an 8.02% 90-day complication rate with short segment robotic-guided fusions and 83.2% reduction in complications compared to freehand technique (p<0.001) [18].…”

Section: Discussionmentioning

confidence: 99%

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A Multi-surgeon Robotic-guided Thoracolumbar Fusion Experience: Accuracy, Radiation, Complications, Readmissions, and Revisions of 3,874 Screws across Three Robotic Generations

Thomson

Orosz

Haines

et al. 2022

J Minim Invasive Spine Surg Tech

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Objective: Robotic guidance provides indirect visualization of key anatomic landmarks to facilitate minimally invasive surgery (MIS) and is emerging as a reliable and accurate technique for posterior spine instrumentation. We sought to describe eight years of experience with robotic guidance at a high-volume, multi-surgeon center. We hypothesize that robotic guidance will lead to (1) low rates of complication, readmissions, and revision surgery, (2) reduced fluoroscopic radiation exposure, (3) and accurate thoracolumbar instrumentation. Methods: A retrospective review of complications, revision surgery, and readmission rates in patients undergoing thoracolumbar fusion surgery utilizing three robotic generations. Secondary analysis was conducted comparing the three robotic generations for complications, revision surgery, accuracy, and readmission rates along with intraoperative fluoroscopic duration. Results: A total of 628 patients (3,874 robotic-guided screws) ages 12-81 years-old (43.9% male) were included in the study. At one year, the cumulative complication incidence was 15.5% with a 10.3% incidence of surgical complications (3.7% wound, 1.2% robot-related, and 5.4% non-robot-related complications). At one year, the revision surgery incidence was 9.4%. There was no statistical difference between complications, readmission, or revision surgery after initial admission among the three robotic generations. The average intraoperative fluoroscopic duration was 53.8 seconds (11.9 seconds per screw and 17.6 seconds per instrumented level). Conclusion: Robotic guidance in thoracolumbar instrumented fusions was associated with low complication, revision surgery, and readmission rates. Our results suggest robotic guidance can provide accurate guidance with minimal adverse events in thoracolumbar instrumentation.

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“…Similarly, a retrospective study of complications and revision rates after lumber fusion reported fewer complications and fewer revisions at 90 days and 1-year for those who underwent robotic-assisted surgery. 64 Moreover, type of complications can differ between robotic and freehand operations. In a systematic review that did not find significant differences overall in neither pedicle screw placement accuracy nor rate of complications, the type of complications reported did differ.…”

Section: Patient Safety and Complicationsmentioning

confidence: 99%

Robotic Spine Surgery: Past, Present and Future.

Perfetti

Kisinde

Rogers-LaVanne

et al. 2022

Spine

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Study Design. Systematic review. Objective. The aim of this review is to present an overview of robotic spine surgery (RSS) including its history, applications, limitations, and future directions. Summary of Background Data. The first RSS platform received United States Food and Drug Administration approval in 2004. Since then, robotic-assisted placement of thoracolumbar pedicle screws has been extensively studied. More recently, expanded applications of RSS have been introduced and evaluated. Methods. A systematic search of the Cochrane, OVID-MEDLINE, and PubMed databases was performed for articles relevant to robotic spine surgery. Institutional review board approval was not needed. Results. The placement of thoracolumbar pedicle screws using RSS is safe and accurate and results in reduced radiation exposure for the surgeon and surgical team. Barriers to utilization exist including learning curve and large capital costs. Additional applications involving minimally invasive techniques, cervical pedicle screws, and deformity correction have emerged. Conclusion. Interest in RSS continues to grow as the applications advance in parallel with image guidance systems and minimally invasive techniques. IRB Approval. N/A.

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Reduction in complication and revision rates for robotic-guided short-segment lumbar fusion surgery: results of a prospective, multi-center study

Cited by 13 publications

References 34 publications

Initial Intraoperative Experience with Robotic-Assisted Pedicle Screw Placement with Cirq® Robotic Alignment: An Evaluation of the First 70 Screws

Initial Intraoperative Experience with Robotic-Assisted Pedicle Screw Placement with Cirq® Robotic Alignment: An Evaluation of the First 70 Screws

A Multi-surgeon Robotic-guided Thoracolumbar Fusion Experience: Accuracy, Radiation, Complications, Readmissions, and Revisions of 3,874 Screws across Three Robotic Generations

Robotic Spine Surgery: Past, Present and Future.

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