Assessment of Surgical Procedural Time, Pedicle Screw Accuracy, and Clinician Radiation Exposure of a Novel Robotic Navigation System Compared With Conventional Open and Percutaneous Freehand Techniques: A Cadaveric Investigation

Vaccaro, Alexander R.; Harris, Jonathan; Hussain, Mir; Wadhwa, Rishi; Chang, Victor; Schroerlucke, Samuel R.; Samora, Walter; Passias, Peter G.; Patel, Rakesh; Panchal, Ripul R.; D'Agostino, Sabino; Whitney, Nathaniel; Crawford, Neil R.; Bucklen, Brandon

doi:10.1177/2192568219879083

Cited by 32 publications

(26 citation statements)

References 35 publications

(125 reference statements)

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“…These results are similar to the results published by Vaccaro et al. using the ExcelsiusGPS® robotic platform, in which 100% of the screws were graded A and B [ 20 ]. No significant accuracy differences were seen compared to the ROSA ONE® platform, which showed 97.3% grade A and B screw accuracy in a previously published study [ 25 ].…”

Section: Discussionsupporting

confidence: 90%

“…The pre-placement of the screw (system set-up) time was non-significantly shorter in the Fusion Robotics TM group (21 ± 2.1 versus 35.8 ± 14.9 minutes). Also, compared to published data regarding the ExcelsiusGPS® robotic platform, the pre-placement screw time (28.1 ± 5.2 versus 21 ± 2.1 minutes) was significantly shorter for the Fusion Robotics TM platform while the total operative time (41.4 ± 8.8 versus 36.6 ± 4.6 minutes) was non significantly shorter [ 20 ]. With regard to the screw placement time, there were no significant differences between the Fusion Robotics TM , Mazor-X TM , and ExcelsiusGPS® robotic platforms [ 20 ].…”

Section: Discussionmentioning

confidence: 93%

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

Soliman¹,

Khan²,

O’Connor³

et al. 2021

Cureus

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 93%

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

Soliman¹,

Khan²,

O’Connor³

et al. 2021

Cureus

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“…In total, including set up time, the robot-assisted portion of this procedure took 68 minutes to place six screws. These times compare favorably with the reported operative time for screw placement by conventional freehand techniques [ 10 , 14 , 15 ].…”

Section: Discussionsupporting

confidence: 61%

Anterior Lumbar Interbody Fusion With Robotic-Assisted Percutaneous Screw Placement: A Case Report

McVeigh¹,

Anokwute²,

Huh³

et al. 2022

Cureus

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Recently, there has been an increase in robotic-assisted spine fusion for degenerative spondylosis of the lumbar spine. We present the case of a 60-year-old female with grade 1 spondylolisthesis at L4/5 and L5/S1 who underwent L4-S1 anterior lumbar interbody fusion (ALIF) with percutaneous robotic-assisted pedicle screw fixation. We provide a detailed analysis of the procedure including the speed of robotic screw placement and pitfalls of this surgical approach.

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“…The robot was operated in a "sharedcontrol" mode, allowing for both the surgeon and robotic arm to dictate motions. 23 Pedicle screw dimensions were templated using the patient-specific intraoperative plan and then placed using the floor-mounted robotic arm for guidance. The remainder of the procedure was performed using RN interbody cage placement, as described in prior publications.…”

Section: Rn Operative Techniquementioning

confidence: 99%

Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery?

Shafi

Pompeu

Vaishnav

et al. 2022

Neurosurgical Focus

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OBJECTIVE The accuracy of percutaneous pedicle screw placement has increased with the advent of robotic and surgical navigation technologies. However, the effect of robotic intraoperative screw size and trajectory templating remains unclear. The purpose of this study was to compare pedicle screw sizes and accuracy of placement using robotic navigation (RN) versus skin-based intraoperative navigation (ION) alone in minimally invasive lumbar fusion procedures. METHODS A retrospective cohort study was conducted using a single-institution registry of spine procedures performed over a 4-year period. Patients who underwent 1- or 2-level primary or revision minimally invasive surgery (MIS)–transforaminal lumbar interbody fusion (TLIF) with pedicle screw placement, via either robotic assistance or surgical navigation alone, were included. Demographic, surgical, and radiographic data were collected. Pedicle screw type, quantity, length, diameter, and the presence of endplate breach or facet joint violation were assessed. Statistical analysis using the Student t-test and chi-square test was performed to evaluate the differences in pedicle screw sizes and the accuracy of placement between both groups. RESULTS Overall, 222 patients were included, of whom 92 underwent RN and 130 underwent ION MIS-TLIF. A total of 403 and 534 pedicle screws were placed with RN and ION, respectively. The mean screw diameters were 7.25 ± 0.81 mm and 6.72 ± 0.49 mm (p < 0.001) for the RN and ION groups, respectively. The mean screw length was 48.4 ± 4.48 mm in the RN group and 45.6 ± 3.46 mm in the ION group (p < 0.001). The rates of “ideal” pedicle screws in the RN and ION groups were comparable at 88.5% and 88.4% (p = 0.969), respectively. The overall screw placement was also similar. The RN cohort had 63.7% screws rated as good and 31.4% as acceptable, while 66.1% of ION-placed screws had good placement and 28.7% had acceptable placement (p = 0.661 and p = 0.595, respectively). There was a significant reduction in high-grade breaches in the RN group (0%, n = 0) compared with the ION group (1.2%, n = 17, p = 0.05). CONCLUSIONS The results of this study suggest that robotic assistance allows for placement of screws with greater screw diameter and length compared with surgical navigation alone, although with similarly high accuracy. These findings have implied that robotic platforms may allow for safe placement of the “optimal screw,” maximizing construct stability and, thus, the ability to obtain a successful fusion.

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Assessment of Surgical Procedural Time, Pedicle Screw Accuracy, and Clinician Radiation Exposure of a Novel Robotic Navigation System Compared With Conventional Open and Percutaneous Freehand Techniques: A Cadaveric Investigation

Cited by 32 publications

References 35 publications

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

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

Anterior Lumbar Interbody Fusion With Robotic-Assisted Percutaneous Screw Placement: A Case Report

Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery?

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