Accuracy of pedicle screw placement comparing robot-assisted technology and the free-hand with fluoroscopy-guided method in spine surgery

Fan, Yong; Du, Jin Peng; Liu, Ji Jun; Zhang, Jianan; Qiao, Huan Huan; Liu, Shi Chang; Hao, Ding Jun

doi:10.1097/md.0000000000010970

Cited by 125 publications

(132 citation statements)

References 23 publications

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“…In a meta-analysis by Fan et al [16], robot-assisted pedicle screws were significantly more accurate than the conventional freehand with fluoroscopy-guided method. After comparing the accuracies of 1255 pedicle screws in the freehand group to 1682 pedicle screws in the robot-assisted group, it was concluded that the robot-assisted technique was superior to the conventional method in terms of pedicle screw accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…The current study was not a comparative study, but rather an exploratory study on the effectiveness of navigated robotic assistance in posterior screw placement. Multiple studies have examined the screw accuracy of robot-assisted screws versus freehand screw placement with fluoroscopy guidance and found improved screw accuracy, lower radiation, improved outcomes, and fewer revisions from screw malposition with navigated robotic assistance [16][17][18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

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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: 99%

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…In a meta‐analysis focusing on the comparison of the accuracies of robot‐assisted and free‐hand pedicle screws insertion, 10 studies were included and analyzed. The study showed that the robot‐assisted technique is more accurate than the conventional method after analyzing the incidences of “perfect” and “clinical acceptable” pedicle screw insertions.…”

Section: Introductionmentioning

confidence: 99%

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Yuan

Liu

et al. 2019

Orthopaedic Surgery

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Objectives Percutaneous transfacet screw fixation (pTSF) is a minimally invasive posterior fixation technique supplementing oblique lateral interbody fusion (OLIF) for lumbar spinal disorders. Accurate screw insertion is difficult to achieve and technically demanding under 2‐D fluoroscopy. Recently developed robot‐assisted spinal surgery demonstrated a high level of accuracy of pedicle screw insertion and a low complication rate. No published study has reported this combination technique. The aim of our study was to evaluate the accuracy and safety properties of the combination of both minimally invasive techniques: robot‐assisted pTSF supplementing the OLIF procedure. Methods This was an experimental and prospective study. Selected consecutive patients with lumbar degenerative disorders received robot‐assisted pTSF supplementing the OLIF procedure using the TianJi Robot system operated by one senior surgeon from March to October 2018. The accuracy of screw insertion and perioperative screw‐related complications were evaluated. Assessment of the accuracy of screw insertion included intraoperative robotic guidance accuracy and incidence of screw encroachments. Intraoperative robotic guidance accuracy referred to translational and angular deviations of screws, which were assessed by comparing the planned and actual screw trajectories guided by the robot on reconstructed images using TianJi Robot Planning Software. Screw encroachments were evaluated on postoperative CT images and classified by a grading system (A, excellent; B, good; C, poor). Screw‐related complications including intraoperative pin skidding, screw malposition and adjustment, together with postoperative neurological symptoms that correlated with screw malposition were recorded. Results Ten patients, with an average age of 60.2 years, were selected and recruited in this study. All cases were degenerative lumbar spinal disorders, out of which there were 6 cases of Meyerding Grade I degenerative spondylolisthesis. Twenty‐four transfacet screws were inserted by robotic assistance. Instrumented levels included nine segments at L 4–5 level and three segments at L 3–4 level. Two patients had both L 4–5 and L 3–4 level fixation. The average surgical time was 3.3 h (SD, 0.8 h). The mean blood loss was 90 mL (SD, 32 mL). Intraoperative guidance accuracy showed 1.09 ± 0.17 mm (ranging from 0.75 to 1.22 mm) translational deviation and 2.17° ± 0.39° (ranging from 1.47° to 2.54°) angular deviation. The gradings of screw encroachment were: 17 screws (71%) with Grade A, 6 screws (25%) with Grade B, and 1 screw (4%) with Grade C. Only one pin skidding occurred intraoperatively and revised subsequently. No postoperative neurological complications were found. Conclusion Our preliminary study of robot‐assisted pTSF supplementing the OLIF procedure showed a hig...

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“…This was also reflected on the length of stay of patients operated with the use of robotic surgery: in fact, Hyun et al 28 showed an average length of stay of 9.4 days for FH procedures vs. 6.8 days for robotic surgical procedures. Likewise, Fan et al 80 demonstrated a decrease of number in postoperative days from 6.3 ± 1.2 in the RAN group vs. 8.9 ± 1.8 in the FH group.…”

Section: Discussionmentioning

confidence: 87%

“…79 Moreover, robotic spine surgery gives the possibility to operate with a lower risk of neurovascular damage if compared to FH approaches, thanks to the use of motors and stabilizers. 80 As far as the reoperation rate is concerned, Kantelhardt et al 81 demonstrated that only 1% of robotic procedures (including both percutaneous and open approaches) needed revision surgery, compared to the 12.2% reoperation rate showed for conventional procedures. Moreover, the study reported postoperative infections in 2.7% of the patients undergoing robot-guided procedures compared to 10.7% in open nonrobotic ones.…”

Section: Discussionmentioning

confidence: 99%

Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

et al. 2020

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Instrumented spine procedures have been performed for decades to treat a wide variety of spinal disorders. New technologies have been employed to obtain a high degree of precision, to minimize risks of damage to neurovascular structures and to diminish harmful exposure of patients and the operative team to ionizing radiations. Robotic spine surgery comprehends 3 major categories: telesurgical robotic systems, robotic-assisted navigation (RAN) and virtual augmented reality (AR) systems, including AR and virtual reality. Telesurgical systems encompass devices that can be operated from a remote command station, allowing to perform surgery via instruments being manipulated by the robot. On the other hand, RAN technologies are characterized by the robotic guidance of surgeon-operated instruments based on real-time imaging. Virtual AR systems are able to show images directly on special visors and screens allowing the surgeon to visualize information about the patient and the procedure (i.e., anatomical landmarks, screw direction and inclination, distance from neurological and vascular structures etc.). The aim of this review is to focus on the current state of the art of robotics and AR in spine surgery and perspectives of these emerging technologies that hold promises for future applications.

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Accuracy of pedicle screw placement comparing robot-assisted technology and the free-hand with fluoroscopy-guided method in spine surgery

Abstract: There are significant differences in accuracy between RA surgery and FH surgery. It was demonstrated that the RA technique is superior to the conventional method in terms of the accuracy of pedicle screw placement.

Cited by 125 publications

References 23 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

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

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