Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review

Abstract

Purpose At present, most spinal surgeons undertake pedicle screw implantation using either anatomical landmarks or C-arm fluoroscopy. Reported rates of screw malposition using these techniques vary considerably, though the evidence generally favors the use of imageguidance systems. A miniature spine-mounted robot has recently been developed to further improve the accuracy of pedicle screw placement. In this systematic review, we critically appraise the perceived benefits of robot-assisted pedicle screw placement compared to conventional fluoroscopy-guided technique. Methods The Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases were searched between January 2006 and January 2013 to identify relevant publications that (1) featured placement of pedicle screws, (2) compared robot-assisted and fluoroscopy-guided surgery, (3) assessed outcome in terms of pedicle screw position, and (4) present sufficient data in each arm to enable meaningful comparison ([10 pedicle screws in each study group). Results A total of 246 articles were retrieved, of which 5 articles met inclusion criteria, collectively reporting placement of 1,308 pedicle screws (729 robot-assisted, 579 fluoroscopy-guided). The findings of these studies are mixed, with limited higher level of evidence data favoring fluoroscopy-guided procedures, and remaining comparative studies supporting robot-assisted pedicle screw placement. Conclusions There is insufficient evidence to unequivocally recommend one surgical technique over the other. Given the high cost of robotic systems, and the high risk of spinal surgery, further high quality studies are required to address unresolved clinical equipoise in this field.

Pedicle screw accuracy assessment in ExcelsiusGPS® robotic spine surgery: evaluation of deviation from pre-planned trajectory

“…Pedicle screw insertion accuracy in robotic assisted spinal surgery has been well studied and reported to be superior compared to conventional fluoroscopic-guided or free-hand techniques [11][12][13][14][15][16][17][18]. The majority of these studies assess accuracy based on the Gertzbein-Robbins scale, which evaluates for pedicle/cortical breach based on an idealized and optimized trajectory [12].…”

Minimally invasive versus conventional fixation of tracer in robot-assisted pedicle screw insertion surgery: a randomized control trial

“…The tracer was fastened to the bone around the surgical field and collected the corresponding intraoperative image. Finally, the imageguided surgery was accomplished through tracer positions of navigational system [16][17][18][19].…”

Robotic-Assisted Systems for Spinal Surgery

“…However, it is crucial to acknowledge the results by Ringel et al that noted lower screw insertion accuracy with the use of surgical robotic system. A number of possible reasons could have led to these findings including lateral skidding of the cannula at the entrance point caused by the steep slope of the lateral aspect of the facet joint or using a platform fixed to a cranial spinal process with a K-wire and attached to the operating table by a bed mount, which meant the robot was only attached to the patient via a single K-wire [43].…”