Robotic and navigated pedicle screws are safer and more accurate than fluoroscopic freehand screws: a systematic review and meta-analysis

Matur, Abhijith V.; Palmisciano, Paolo; Duah, Henry Ofori; Chilakapati, Sai; Cheng, Joseph; Adogwa, Owoicho

doi:10.1016/j.spinee.2022.10.006

Cited by 40 publications

(26 citation statements)

References 35 publications

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“…The precision of pedicular screw placement has been a significant consideration in spinal surgery for years, 21 with current techniques including the surgeon's experience with mechanical feedback, navigation and robotic systems, spinal cord monitoring, and others. 22,23 These techniques offer their own benefits, and also have drawbacks such as high cost, reliance on operator skill, and the need for neurophysiologists. 24 Additionally, surgeons face exposure to both direct and scattered ionizing radiation during procedures.…”

Section: Advantages Of Ecd In Spinal Surgerymentioning

confidence: 99%

Spine Surgery with Electronic Conductivity Device: A Prospectively Multicenter Randomized Clinical Trial and Literature Review

Zhai,

Li,

Chen

et al. 2023

Orthopaedic Surgery

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ObjectiveImproving accuracy and safety of pedicle screw placement is of great clinical importance. Electronic conductivity device (ECD) can be a promising technique with features of affordability, portability, and real‐time detection capabilities. This study aimed to validate the safety and effectiveness of a modified ECD.MethodsThe ECD underwent a modification where six lamps of various colors, and it was utilized in a prospectively multicenter randomized controlled clinical trial involving 96 patients across three hospitals from June 2018 to December 2018. The trial incorporated a self‐control randomization with an equal distribution of left or right side of vertebral pedicle among two groups: the free‐hand group and the ECD group. A total of 496 pedicle screws were inserted, with 248 inserted in each group. The primary outcomes focused on the accuracy of pedicle screw placement and the frequency of intraoperative X‐rays. Meanwhile, the secondary indicator measured the time required for pedicle screw placement. Results were presented as means ± SD. Paired samples t‐test and χ2‐test were used for comparison. Furthermore, an updated review was conducted, which included studies published from 2006 onwards.ResultsBaseline patient characteristics were recorded. The primary accuracy outcome revealed a 96.77% accuracy rate in the ECD group, compared to a 95.16% accuracy rate in the free‐hand group, with no significant differences noted. In contrast, ECD demonstrated a significant reduction in radiation exposure frequency when compared to the free‐hand group (1.11 ± 0.32 vs. 1.30 ± 0.53; p < 0.001), resulting in a 14.6% reduction. Moreover, ECD displayed a decrease of 30.38% in insertion time (70.88 ± 30.51 vs. 101.82 ± 54.00 s; p < 0.001). According to the results of the 21 studies, ECD has been utilized in various areas of the spine such as the atlas, thoracic and lumbar spine, as well as sacral 2‐alar‐iliac. The accuracy of ECD ranged from 85% to 100%.ConclusionThe prospectively randomized trial and the review indicate that the use of ECD presents a secure and precise approach to the placement of pedicle screws, with the added benefit of reducing both procedure time and radiation exposure.

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Section: Advantages Of Ecd In Spinal Surgerymentioning

confidence: 99%

Spine Surgery with Electronic Conductivity Device: A Prospectively Multicenter Randomized Clinical Trial and Literature Review

Zhai,

Li,

Chen

et al. 2023

Orthopaedic Surgery

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“…46 Semiautomated systems using ML have already been developed to complement existing ORs. [47][48][49][50][51] One example is a positioning model that automatically adjusts the C-Arm to desired angles to reduce surgical time, manual acquisitions, and radiation exposure. 52…”

Section: Surgical Navigationmentioning

confidence: 99%

Machine Learning in Spine Surgery: A Narrative Review

Adida,

Legarreta,

Hudson

et al. 2023

Neurosurgery

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Artificial intelligence and machine learning (ML) can offer revolutionary advances in their application to the field of spine surgery. Within the past 5 years, novel applications of ML have assisted in surgical decision-making, intraoperative imaging and navigation, and optimization of clinical outcomes. ML has the capacity to address many different clinical needs and improve diagnostic and surgical techniques. This review will discuss current applications of ML in the context of spine surgery by breaking down its implementation preoperatively, intraoperatively, and postoperatively. Ethical considerations to ML and challenges in ML implementation must be addressed to maximally benefit patients, spine surgeons, and the healthcare system. Areas for future research in augmented reality and mixed reality, along with limitations in generalizability and bias, will also be highlighted.

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“…However, tactile feedback and experience‐based judgment are of utmost importance in present techniques. The misplacement rate in the lumbar spine was reported to range from 8.3% to 50.6% 2,11 . Additionally, in cases with lumbar spondylolysis, vertebral fracture, and severe hyperplasia or degeneration of the facet joint, the crista lambdoidalis can be difficult to distinguish.…”

Section: Introductionmentioning

confidence: 99%

A Novel Free‐hand Technique of Pedicle Screw Placement in the Lumbar Spine: Accuracy Evaluation and Preliminary Clinical Results

Jiang

Leng

Meng

et al. 2023

Orthopaedic Surgery

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ObjectivePedicle screw implantation is the most common technique to achieve stability during spinal surgeries. Current methods for locating the entry point do not have a quantified criteria and highly rely on the surgeons' experience. Therefore, we aim to propose a quantified pedicle screw placement technique in the lumbar spine and to investigate its accuracy and safety in clinical practice.MethodsWe conducted a retrospective study involving 110 patients who received spinal surgery in our hospital from August 2018 to August 2021. All patients included had herniation of a single lumbar disc and were consistently treated with posterior discectomy, inter‐body fusion, and transpedicular internal fixation. For 54 patients in the observation group, the pedicle screws were placed with our technique, which is located at 4 mm below the superior edge of the transverse process in line with the lateral margin of the superior articular process. For 56 patients in the control group, pedicle screws were placed according to the traditional crista lambdoidalis method. Comparisons were made in terms of the operation time, blood loss, time for exposure, the accuracy of placement, and postoperative complications. Furthermore, we applied our method to 64 patients with indistinguishable crista lambdoidalis and evaluated the accuracy of screw placement and clinical outcomes according to the visual analogue scale (VAS) and the Japanese Orthopaedic Association (JOA) score.ResultsThere was no significant difference in intraoperative bleeding, accuracy of placement, and postoperative complications between our technique and the traditional crista lambdoidalis method (P > 0.05). However, the exposure time before screw placement (12.8 ± 0.3 vs. 17.4 ± 0.3, P = 0.001) and the total surgery time (97.2 ± 1.9 vs 102.3 ± 0.9, P = 0.020) were significantly shortened with our method. Additionally, in cases with indistinguishable crista lambdoidalis, our technique showed satisfying accuracy, with 97.6% screws placed in appropriate trajectory on the first attempt and all screws eventually positioned in the safe zone according to the Gertzbein–Robbins grading. All patients experienced steady improvement after surgery.ConclusionPlacing pedicle screws at 4 mm below the superior edge of the transverse process in line with the lateral margin of the superior articular process is a viable pedicle screw placement method. With this method, we observed a higher success rate and shorter operation time. In addition, this method can be applied in cases with indistinguishable crista lambdoidalis, and have satisfied success rate and clinical outcome.

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Robotic and navigated pedicle screws are safer and more accurate than fluoroscopic freehand screws: a systematic review and meta-analysis

Cited by 40 publications

References 35 publications

Spine Surgery with Electronic Conductivity Device: A Prospectively Multicenter Randomized Clinical Trial and Literature Review

Spine Surgery with Electronic Conductivity Device: A Prospectively Multicenter Randomized Clinical Trial and Literature Review

Machine Learning in Spine Surgery: A Narrative Review

A Novel Free‐hand Technique of Pedicle Screw Placement in the Lumbar Spine: Accuracy Evaluation and Preliminary Clinical Results

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