Robotics in spinal surgery

Galetta, Matthew S.; Leider, Joseph; Divi, Srikanth N.; Goyal, Dhruv K.C.; Schroeder, Gregory D.

doi:10.21037/atm.2019.07.93

Cited by 29 publications

(18 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, we can never avoid the development of bone grinding arms in the development of spinal surgery robots. This research advances the development of a safe cortical bone treatment technique that never damages nerves as a program by linking tissue characteristics with precise position information and linking information obtained from sensors such as drill vibrations with position information [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Fluid Lubrication and Cooling Effects in Diamond Grinding of Human Iliac Bone

et al. 2021

View full text Add to dashboard Cite

Background and Objectives: Although there have been research on bone cutting, there have been few research on bone grinding. This study reports the measurement results of the experimental system that simulated partial laminectomy in microscopic spine surgery. The purpose of this study was to examine the fluid lubrication and cooling in bone grinding, histological characteristics of workpieces, and differences in grinding between manual and milling machines. Materials and Methods: Thiel-fixed human iliac bones were used as workpieces. A neurosurgical microdrill was used as a drill system. The workpieces were fixed to a 4-component piezo-electric dynamometer and fixtures, which was used to measure the triaxial power during bone grinding. Grinding tasks were performed by manual activity and a small milling machine with or without water. Results: In bone grinding with 4-mm diameter diamond burs and water, reduction in the number of sudden increases in grinding resistance and cooling effect of over 100 °C were confirmed. Conclusion: Manual grinding may enable the control of the grinding speed and cutting depth while giving top priority to uniform torque on the work piece applied by tools. Observing the drill tip using a triaxial dynamometer in the quantification of surgery may provide useful data for the development of safety mechanisms to prevent a sudden deviation of the drill tip.

show abstract

Section: Discussionmentioning

confidence: 99%

Fluid Lubrication and Cooling Effects in Diamond Grinding of Human Iliac Bone

et al. 2021

View full text Add to dashboard Cite

show abstract

“…17 Additionally, with equipment for robot-assisted surgery costing up to $1 million in addition to annual costs of disposables, AR systems are significantly cheaper tools with similar potential to radically improve spinal surgery. 18,19 These studies used preoperative volume-rendering or cadaveric imaging to generate 3D models. However, preoperative imaging may not adequately account for changes in anatomical orientation, alignment, or position of regions of interest between the preoperative and intraoperative state.…”

Section: Discussionmentioning

confidence: 99%

Development of an Intraoperative Pipeline for Holographic Mixed Reality Visualization During Spinal Fusion Surgery

et al. 2020

View full text Add to dashboard Cite

Objective. Holographic mixed reality (HMR) allows for the superimposition of computer-generated virtual objects onto the operator’s view of the world. Innovative solutions can be developed to enable the use of this technology during surgery. The authors developed and iteratively optimized a pipeline to construct, visualize, and register intraoperative holographic models of patient landmarks during spinal fusion surgery. Methods. The study was carried out in two phases. In phase 1, the custom intraoperative pipeline to generate patient-specific holographic models was developed over 7 patients. In phase 2, registration accuracy was optimized iteratively for 6 patients in a real-time operative setting. Results. In phase 1, an intraoperative pipeline was successfully employed to generate and deploy patient-specific holographic models. In phase 2, the registration error with the native hand-gesture registration was 20.2 ± 10.8 mm (n = 7 test points). Custom controller-based registration significantly reduced the mean registration error to 4.18 ± 2.83 mm (n = 24 test points, P < .01). Accuracy improved over time (B = −.69, P < .0001) with the final patient achieving a registration error of 2.30 ± .58 mm. Across both phases, the average model generation time was 18.0 ± 6.1 minutes (n = 6) for isolated spinal hardware and 33.8 ± 8.6 minutes (n = 6) for spinal anatomy. Conclusions. A custom pipeline is described for the generation of intraoperative 3D holographic models during spine surgery. Registration accuracy dramatically improved with iterative optimization of the pipeline and technique. While significant improvements and advancements need to be made to enable clinical utility, HMR demonstrates significant potential as the next frontier of intraoperative visualization.

show abstract

“…The Excelsius GPS released by Globus Medical (Audubon, PA) in 2018, received FDA approval for use in spine surgery in 2019. This system uses proprietary software for planning pedicle screw trajectories and an automated robotic arm to guide instruments simultaneously with navigation technology and has proved to be safe and effective as a means for inserting pedicle screws (Galetta et al 2019). A recent single institution study demonstrated a 99% rate of successful pedicle screw placement out of 562 screws placed using the Excelsius GPS system in minimally invasive lumbar spine surgery using a variety of approaches (Huntsman et al 2020).…”

Section: Excelsius Gpsmentioning

confidence: 99%

Robotic Technology

Holmberg

Altman

Cheng

et al. 2020

Handbook of Spine Technology

View full text Add to dashboard Cite

With increasing numbers of patients requiring spine surgery, there has been an emphasis on technological advances designed to enhance surgical outcomes and improve patient safety. In particular, the number of elective spinal fusion surgeries in the USA continues to increase. Instrumentation of the spine with pedicle screws is frequently used for indications including deformity and instability. With neurovascular structures near the pedicle, accurate screw placement is of paramount importance to ensure good outcomes. Reported complications related to pedicle screw malposition range from 1% to 54% (Molliqaj et al., Neurosurg Focus 42(5): E14, 2017). Currently, there are several techniques described for inserting pedicle screws, including freehand manual insertion based on anatomic landmarks and fluoroscopy, manual insertion with navigation assistance systems, and robotic-assisted methods.

show abstract

Robotics in spinal surgery

Cited by 29 publications

References 40 publications

Fluid Lubrication and Cooling Effects in Diamond Grinding of Human Iliac Bone

Fluid Lubrication and Cooling Effects in Diamond Grinding of Human Iliac Bone

Development of an Intraoperative Pipeline for Holographic Mixed Reality Visualization During Spinal Fusion Surgery

Robotic Technology

Contact Info

Product

Resources

About