Robotic spine surgery: Ushering in a new era

Garg, Bhavuk; Mehta, Nishank; Malhotra, Rajesh

doi:10.1016/j.jcot.2020.04.034

Cited by 17 publications

(11 citation statements)

References 59 publications

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“…[24,25] However, in severe spine deformity surgery, the evidence was unpowered and insu cient. [26] Yang et al reported that 3D technology could reduce the misplacement rate, operating time and blood loss in patients with preoperative mean Cobb angle only > 50°. [27] According to our experience, the application of robotic navigation technology in the operation of severe spinal deformity was not accurate and convenient enough.…”

Section: Discussionmentioning

confidence: 99%

The Value of Three-Dimensional Printing Spine Model in Severe Spine Deformity Correction Surgery

Pan

Ding

Hai

et al. 2020

Preprint

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Objective. We aimed to evaluate the value of 3-dimensional printing (3DP) spine model in the surgical treatment of severe spinal deformity since the prosperous development of 3DP technology.Materials and Methods. Severe scoliosis or hyper-kyphosis patients underwent posterior fixation and fusion surgery using the 3DP spine models were reviewed (3DP group). Spinal deformity surgeries operated by free-hand screw implantation during the same period were selected as the control group after propensity score matching (PSM). The correction rate, pedicle screw accuracy, and complications were analyzed. Class A and B screws were defined as accurate according to Gertzbein and Robbins criteria.Results. 35 patients were enrolled in the 3DP group and 35 matched cases were included in the control group. The perioperative baseline data and deformity correction rate were similar between both groups (P>0.05). However, the operation time and blood loss were significantly less in the 3DP group (296.14±66.18 min vs. 329.43±67.16 min, 711.43±552.28 mL vs. 1322.29±828.23 mL, P<0.05). More three-column osteotomies (Grade 3-6) were performed in the 3DP group (30/35, 85.7% vs. 21/35, 60.0%. P=0.016). The screw placement accuracy was significantly higher in the 3DP group (422/582, 72.51% vs. 397/575, 69.04%. P=0.024). The screw misplacement related complication rate was significantly higher in the free-hand group (6/35 vs. 1/35, P=0.046).Conclusion. The study provided solid evidence that 3DP spine models can enhance surgeons' confidence in performing higher grade osteotomies and improve the safety and efficiency in severe spine deformity correction surgery. 3D printing technology has a good prospect in spinal deformity surgery.

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Section: Discussionmentioning

confidence: 99%

The Value of Three-Dimensional Printing Spine Model in Severe Spine Deformity Correction Surgery

Pan

Ding

Hai

et al. 2020

Preprint

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“…The gold standard for instrumented posterior arthrodesis is pedicle screw fixation; however, open free‐hand placement with or without image‐guided navigation has resulted in inaccurately placed screws 13 . Improvements in robotic technology has led to use of robots during spine surgery.…”

Section: Lumbar Fusion Overviewmentioning

confidence: 99%

Robotic‐Assisted Lumbar Fusion: An Effective Technique for Pedicle Screw Placement

Karasin¹,

Rizzo²,

Hardinge³

et al. 2022

AORN Journal

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Degenerative lumbar disease is a common condition in which progressive deterioration of the structures in the spine causes severely incapacitating pain and disability. Conservative management, including passive or active physical therapy, activity modification, and medications (eg, anti‐inflammatory medications, oral and injectable steroids, opioids), may provide relief. However, when conservative management is unsuccessful or patients experience symptoms for an extended period of time, they may require spine surgery. Surgeons use a variety of techniques to perform lumbar fusion procedures with instrumentation, including open, percutaneous, minimally invasive, and robotic‐assisted with navigation. The accuracy of pedicle‐screw placement varies according to the technique used, and accuracy rates are high after robotic‐assisted with navigation procedures. In addition, robotic‐assisted spine procedures result in fewer infections than non–robotic‐assisted spine procedures (P = .04). Perioperative nurses should understand basic lumbar spine anatomy, steps completed during robotic‐assisted lumbar spine surgery, and the nursing considerations for patients undergoing this type of procedure.

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“…These problems are well documented, and troubleshooting has been previously discussed. [54][55][56][57] Of note, registration may be difficult for patients with high body mass index, severe osteoporosis, or extensive spondylotic changes that obfuscate normal landmarks. In these situations, it is critical that the surgeon be well versed in the anatomy of the sacrum and pelvis to obtain adequate bony purchase for placement of the reference marker.…”

Section: Phase 2-preclinical Trainingmentioning

confidence: 99%

“…To this end, other authors have recommended that initial cases be performed under supervision of a trained partner. 55…”

Section: Phase 3-live Surgerymentioning

confidence: 99%

Spine Image Guidance and Robotics: Exposure, Education, Training, and the Learning Curve

et al. 2021

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The use of intraoperative robotics and imaging for spine surgery has been shown to be safe, efficacious, and beneficial to patients, offering accurate placement of instrumentation, decreased operative time and blood loss, and improved postoperative outcomes. Despite these proven benefits, it has yet to be uniformly adopted. One of the major barriers for universal adoption of intraoperative robotics is the learning curve for this complex technology, in conjunction with a lack of formalized training. These same obstacles for universal adoption were faced in the introduction of surgical technology in other disciplines, and the use of this technology has become the standard of care in some of those specialties. Part of the success and widespread implementation of prior novel technology was the introduction of formalized training systems, which are currently lacking in advanced spine surgical technology. Therefore, the future success of intraoperative robotics and imaging for spine surgery depends on the creation of a formalized training system. We detail the best techniques for surgical pedagogy, as well as propose a comprehensive curriculum.

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Robotic spine surgery: Ushering in a new era

Cited by 17 publications

References 59 publications

The Value of Three-Dimensional Printing Spine Model in Severe Spine Deformity Correction Surgery

The Value of Three-Dimensional Printing Spine Model in Severe Spine Deformity Correction Surgery

Robotic‐Assisted Lumbar Fusion: An Effective Technique for Pedicle Screw Placement

Spine Image Guidance and Robotics: Exposure, Education, Training, and the Learning Curve

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