Accuracy and Efficiency of Fusion Robotics™ Versus Mazor-X™ in Single-Level Lumbar Pedicle Screw Placement

Abstract

Introduction There has been a surge in robot utilization in spine surgery over the past five years with the rapid development of new spine robotic platforms. This study aimed to compare a new robotic spine platform from Fusion Robotics TM (Fusion Robotics, Helena, MT) with the widely used Mazor-X TM Stealth Edition robotic platform (Medtronic, Dublin, Ireland) in terms of workflow and lumbar pedicle screw placement accuracy. Methods A cadaver lab was conducted, which included four procedures with single-level lumbar pedicle screw placement using the Fusion Robotics TM system. These four procedures were compared to four propensity-score matched cases with single-level lumbar pedicle screw placement using the Mazor-X TM Stealth Edition. A single surgeon performed all surgeries. The cases were matched in terms of demographics (age, sex, race, BMI) and comorbidities (Charlson Comorbidity Index score). The primary outcome measure was the operative workflow efficiency (duration as measured with a stopwatch by an independent observer). The secondary outcome measures were pedicle screw accuracy and accuracy to plan. Results After propensity-score matching, there were four cases in each group with no significant between-group differences in terms of sex, race, BMI, or surgical levels; however, there were significant differences in terms of age (p=0.01) and comorbidities (p<0.001). The workflow efficiency measurement showed that the Fusion Robotics TM platform had a significantly shorter duration in terms of the system set-up time, planning to in-position time, and total procedure time (p<0.05). However, there was no significant difference between the robotic platforms in terms of creating a sterile barrier, scanning and importing images, creating a plan, screw placement, screw accuracy, and screw accuracy to plan. Conclusion Based on our findings, the Fusion Robotics TM platform had a significantly shorter procedure workflow duration while maintaining the same accuracy as the most commonly used robotic platform (Mazor-X TM ). This is the first study to directly compare different spine surgery robotic systems.

Can a Spine Robot Be More Efficient and Less Expensive While Maintaining Accuracy?

“…A previous study compared the workflow efficiency of inserting 4 pedicle screws into 2 adjacent lumbar vertebrae using this new robotic 3D navigation system (formerly Fusion Robotics) with the Mazor-X Stealth Edition spine robot (Medtronic, Dublin, Ireland). 5 The study showed that, while both systems were accurate, the new robotic navigation system had significantly better workflow efficiency measurements (total procedure time, system setup time, and screw planning to in-position time) than did the Mazor-X Stealth Edition (Figure 3 and Table ). 5…”

“…5 The study showed that, while both systems were accurate, the new robotic navigation system had significantly better workflow efficiency measurements (total procedure time, system setup time, and screw planning to in-position time) than did the Mazor-X Stealth Edition (Figure 3 and Table ). 5…”

“…9 In a prior study comparing the new robotic 3D navigation system with the Mazor-X Stealth Edition, equivalent accuracy was demonstrated for both systems for the placement of lumbar pedicle screws (100% accuracy for each system). 5…”

Pedicle screw path planning for multi‐level vertebral fixation

“…8 For the computer-aided planning approaches, only single vertebral pedicle screw path planning methods were reported. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Wicker et al relies on the geometric constraints of the single vertebral structures, 18 which is further improved by the introduction of safety boundary constraints. 19 More development depends on the correlations between the vertebral bone mineral density (BMD) and the screw placement trajectories from different angles for preoperative screw trajectory planning.…”

“…[20][21][22][23] Recently, several literatures have reported that the 3D preoperative planning approaches can find the optimal screw trajectory through the bone mechanics or BMD characteristics derived from CT images. [24][25][26][27][28][29] Some researchers also optimize the screw trajectory according to the CT image and the geometric characteristics of the vertebral body, for example, by constructing multi-angle projections and marking the avoidance area on the projection plane to find the optimal screw trajectories. 30 Knez et al developed a technology to parameterize the vertebral body and pedicle into mathematical models and register these models to the patient's CT image.…”