A Systematic Review and Meta-Analysis of Perioperative Parameters in Robot-Guided, Navigated, and Freehand Thoracolumbar Pedicle Screw Instrumentation

Siccoli, Alessandro; Klukowska, Anita M.; Schröder, Marc; Staartjes, Victor E.

doi:10.1016/j.wneu.2019.03.196

Cited by 28 publications

(24 citation statements)

References 61 publications

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“…Other studies report an average fluoroscopic exposure time anywhere from 16.8 s to 3.3 min per pedicle screw fixation case [25][26][27][28]. The current investigation reported a radiation exposure time of 17.6 ± 17.4 s for the entire case.…”

Section: Discussionmentioning

confidence: 50%

Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: an evaluation of the first 54 cases

Benech¹,

Perez²,

Benech³

et al. 2019

J Robotic Surg

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Computer-aided navigation and robotic guidance systems have become widespread in their utilization for spine surgery. A recent innovation combines these two advances, which theoretically provides accuracy in spinal screw placement. This study describes the cortical and pedicle screw accuracy for the first 54 cases where navigated robotic assistance was used in a surgical setting. This is a retrospective chart review of the initial 54 patients undergoing spine surgery with pedicle and cortical screws using robotic guidance with navigation. A computed tomography (CT)-based Gertzbein and Robbins System (GRS) was used to classify pedicle screw accuracy. Screw tip, tail, and angulation offsets were measured using image overlay analysis. Screw malposition, reposition, and return to operating room rates were collected. 1 of the first 54 cases was a revision surgery and was excluded from the study. Ten screws were placed without the robot due to surgeon discretion and were excluded for the data analysis of 292 screws. Only 0.68% (2/292) of the robot-assisted screws was repositioned based on surgeon discretion. Based on the GRS CT-based grading, 98.3% (287/292) were graded A or B, 1.0% (3/292) screws were graded C, and only 0.7% (2/292) screws was graded D. The average offset from preoperative plan to actual final placement was 1.9 mm from the tip, 2.3 mm from the tail, and 2.8° of angulation. In the first 53 cases, 292 screws placed with navigated robotic assistance resulted in a high level of accuracy (98.3%), adequate screw offsets from planned trajectory, and zero complications.

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Section: Discussionmentioning

confidence: 50%

Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: an evaluation of the first 54 cases

Benech¹,

Perez²,

Benech³

et al. 2019

J Robotic Surg

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“…In spinal neurosurgery, CT imaging has particular importance in surgical navigation, for example, for the computerassisted insertion of pedicle screws. 22 Thus, high-fidelity sCT imaging combined with navigation systems or surgical robotics [22][23][24][25] could enable the concept of radiationless navigated surgery, enabling the use of computer assistance based on preoperative CT imaging without the need for additional radiation. Still, intraoperative fluoroscopy may be necessary for registration and instrumentation control, but these fluoroscopic doses are minor compared with those experienced by the patient during CT scanning.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging–based synthetic computed tomography of the lumbar spine for surgical planning: a clinical proof-of-concept

Staartjes

Seevinck

Vandertop

et al. 2021

Neurosurgical Focus

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OBJECTIVEComputed tomography scanning of the lumbar spine incurs a radiation dose ranging from 3.5 mSv to 19.5 mSv as well as relevant costs and is commonly necessary for spinal neuronavigation. Mitigation of the need for treatment-planning CT scans in the presence of MRI facilitated by MRI-based synthetic CT (sCT) would revolutionize navigated lumbar spine surgery. The authors aim to demonstrate, as a proof of concept, the capability of deep learning–based generation of sCT scans from MRI of the lumbar spine in 3 cases and to evaluate the potential of sCT for surgical planning.METHODSSynthetic CT reconstructions were made using a prototype version of the “BoneMRI” software. This deep learning–based image synthesis method relies on a convolutional neural network trained on paired MRI-CT data. A specific but generally available 4-minute 3D radiofrequency-spoiled T1-weighted multiple gradient echo MRI sequence was supplemented to a 1.5T lumbar spine MRI acquisition protocol.RESULTSIn the 3 presented cases, the prototype sCT method allowed voxel-wise radiodensity estimation from MRI, resulting in qualitatively adequate CT images of the lumbar spine based on visual inspection. Normal as well as pathological structures were reliably visualized. In the first case, in which a spiral CT scan was available as a control, a volume CT dose index (CTDIvol) of 12.9 mGy could thus have been avoided. Pedicle screw trajectories and screw thickness were estimable based on sCT findings.CONCLUSIONSThe evaluated prototype BoneMRI method enables generation of sCT scans from MRI images with only minor changes in the acquisition protocol, with a potential to reduce workflow complexity, radiation exposure, and costs. The quality of the generated CT scans was adequate based on visual inspection and could potentially be used for surgical planning, intraoperative neuronavigation, or for diagnostic purposes in an adjunctive manner.

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“…Notably, some research indicates that a similar radiation dose was seen between the two methods but no one has reported a higher or increased dose of radiation per screw insertion with the use of robotic compared to freehand surgery (17,29). For example, Siccoli et al did not find an increased intraoperative radiation in robot-assisted and navigated techniques compared with FH (both p > 0.05) (37).…”

Section: Radiation Exposure and Fluoroscopy Timementioning

confidence: 93%

Role of Robotics in Improving Surgical Outcome in Spinal Pathologies

et al. 2020

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A Systematic Review and Meta-Analysis of Perioperative Parameters in Robot-Guided, Navigated, and Freehand Thoracolumbar Pedicle Screw Instrumentation

Cited by 28 publications

References 61 publications

Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: an evaluation of the first 54 cases

Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: an evaluation of the first 54 cases

Magnetic resonance imaging–based synthetic computed tomography of the lumbar spine for surgical planning: a clinical proof-of-concept

Role of Robotics in Improving Surgical Outcome in Spinal Pathologies

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