Three-Dimensional Quantitative Assessment of Pedicle Screw Accuracy in Clinical Utilization of a New Robotic System in Spine Surgery: A Multicenter Study

Abstract

Objective: The objective of this study was to evaluate the accuracy of pedicle screw placement in patients undergoing percutaneous pedicle screw fixation with robotic guidance, using a newly developed 3-dimensional quantitative measurement system. The study also aimed to assess the clinical feasibility of the robotic system in the field of spinal surgery.Methods: A total of 113 patients underwent pedicle screw insertion using the CUVIS-spine pedicle screw guide system (CUREXO Inc.). Intraoperative O-arm images were obtained, and screw insertion pathways were planned accordingly. Image registration was performed using paired-point registration and iterative closest point methods. The accuracy of the robotic-guided pedicle screw insertion was assessed using 3-dimensional offset calculation and the Gertzbein-Robbins system (GRS).Results: A total of 448 screws were inserted in the 113 patients. The image registration success rate was 95.16%. The average error of entry offset was 2.86 mm, target offset was 2.48 mm, depth offset was 1.99 mm, and angular offset was 3.07°. According to the GRS grading system, 88.39% of the screws were classified as grade A, 9.60% as grade B, 1.56% as grade C, 0.22% as grade D, and 0.22% as grade E. Clinically acceptable screws (GRS grade A or B) accounted for 97.54% of the total, with no reported neurologic complications.Conclusion: Our study demonstrated that pedicle screw insertion using the novel robot-assisted navigation method is both accurate and safe. Further prospective studies are necessary to explore the potential benefits of this robot-assisted technique in comparison to conventional approaches.

Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons

“…Since the development and U.S. Food and Drug Administration approval of a robotic spine surgery system overseas, numerous studies have reported on its accuracy, risk factors, and learning curve [ 2 , 9 , 14 , 15 ]. Although Korea entered the field later, the CUVIS-spine robot system was developed using domestic technology and currently being used and clinical results are reported [ 5 , 16 ]. Our experiences with spine surgery have been shared at various domestic conferences to benefit other spinal surgeons.…”

“…1,2 Based on the outcomes of robotic-assisted spine surgery (RASS) to date, the integration of robotics in spine surgery offers numerous benefits. Several studies have documented improved accuracy in pedicle screw placement, [3][4][5] freedom from radiation exposure during surgery, 6 reduced blood loss, and shortened hospital length of stay. 7 These positive results have increased interest in robotic spine surgery and led to explosive growth in the robot-related medical device market.…”

Navigation-Guided/Robot-Assisted Spinal Surgery: A Review Article

“…The CUVIS-spine (Curexo Inc., Seoul, Korea) is a state-of-the-art surgical robotic system specifically designed to enhance the precision and accuracy of pedicle screw placement during spinal surgery. This innovative system comprises a robotic arm, an optical tracking system (Polaris Vega; NDI, Waterloo, ON, Canada), and a sophisticated real-time surgical planning system [ 16 ]. A unique feature of the CUVIS-spine is its ability to utilize intraoperative images to meticulously plan targets for pedicle screw placement.…”

“…Godzik et al [ 34 ] investigated the accuracy of pedicle screws using the ExcelsiusGPS system and reported a breach rate of 3.4% (4 of 116), resulting in an accuracy rate of 96.4%. Ha et al [ 16 ] conducted a study of 448 pedicle screw placements using the CUVIS-spine system in 113 patients. The accuracy rates were 88.4% for grade A, 9.6% for grade B, 1.6% for grade C, 0.2% for grade D, and 0.2% for grade E, with 97.5% clinically acceptable screws and no neurological complications.…”

Artificial Intelligence (AI)-Robotics Started When Human Capability Reached Limit, Human Creativity Begin Again When the Capability of AI-Robotics Reaches a Plateau

“…The first-generation spinal surgery robot has already accumulated a significant amount of clinical data and demonstrated highly successful surgical outcomes. The 1st generation spinal surgery robot utilizes a basic robotic platform and navigation system, incorporating fundamental AI functionalities [ 1 ]. Following this success, it is anticipated that the next generation of robots will soon emerge.…”