Bone-Mounted Miniature Robotic Guidance for Pedicle Screw and Translaminar Facet Screw Placement

Togawa, Daisuke; Kayanja, Mark; Reinhardt, Mary Kay; Shoham, Moshe; Balter, Alin; Friedlander, A.; Knoller, Nachshon; Benzel, Edward C.; Lieberman, Isador H.

doi:10.1227/01.neu.0000249257.16912.aa

Cited by 79 publications

(72 citation statements)

References 40 publications

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“…From a practical standpoint, these new systems are too complicated to be used widely, whereas the accuracy remains suboptimal and highly dependent on multiple variables [24]. However, the technology continues to evolve, increasing its overall ability.…”

Section: Discussionmentioning

confidence: 99%

Placement of pedicle screws in thoracic idiopathic scoliosis: a magnetic resonance imaging analysis of screw placement relative to structures at risk

et al. 2008

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In posterior pedicle screw instrumentation of thoracic idiopathic scoliosis, screw malposition might cause significant morbidity in tems of possible pleural, spinal cord, and aorta injury. Preoperative axial magnetic resonace images (MRI) in 12 consecutive patients with right thoracic adolescent scoliosis, all with King type 3 curves, were analyzed in order to evaluate the relationship between the inserted pedicle screw position to pleura, spinal cord, aorta. Axial vertebral images for each thoracic level were scanned and the simulation of pedicle screw insertion was performed using a digital measurement programme. The angular contact value for each parameter regarding the pleura and spinal cord was measured on both sides of the curve. The aorta-vertebral distance was also measured. Aorta-vertebral distance was found to be decreasing gradually from the cephalad to the caudad with the shortest distance being measured at T12 with a mean of 1.2 mm. Concave-sided screws on T5-T9 and convexsided screws on T2-T3 had the greatest risk to spinal cord injury. Pleural injury is most likely on T4-T9 segments by the convex side screws. T4-T8 screws on the concave side and T11-T12 screws on the convex side may pose risk to the aorta. This MRI-based study demonstrated that in pedicle instrumentation of thoracic levels, every segment deserves special consideration, where computer scanning might be mandatory in immature spine and in patients with severe deformity.

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Section: Discussionmentioning

confidence: 99%

Placement of pedicle screws in thoracic idiopathic scoliosis: a magnetic resonance imaging analysis of screw placement relative to structures at risk

et al. 2008

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“…Details of the device and related surgical techniques have been described previously [7,10,12,14]. A CT scan using 1 mm cuts was obtained preoperatively in all patients for the surgery planning using the proprietary robotic software (Fig.…”

Section: Robotic Guidance System and Surgical Techniquesmentioning

confidence: 99%

“…The need for improved accuracy and consistency in pedicle screw placement has led to the development of various new techniques, such as computer navigated and robotic-assisted spine surgery [7][8][9][10][11]. There are now reports showing that these newer techniques have improved the accuracy of pedicle screw placement [5,12,13].…”

Section: Introductionmentioning

confidence: 99%

“…There are now reports showing that these newer techniques have improved the accuracy of pedicle screw placement [5,12,13]. Computer-assisted robotic devices are now available in the form of a bone mounted positioning tool that guides the surgeon in the placement of pedicle screws according to a preoperatively planned trajectory (Renaissance, Mazor Robotics Ltd., Israel) [7,10]. This new technology is continually improving and may be particularly useful in patients with challenging anatomy.…”

Section: Introductionmentioning

confidence: 99%

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Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients

2012

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Introduction Surgeons' interest in image and/or robotic guidance for spinal implant placement is increasing. This technology is continually improving and may be particularly useful in patients with challenging anatomy. Only through careful clinical evaluation can its successful applications, limitations, and areas for improvement be defined. This study evaluates the outcomes of robotic-assisted screw placement in a consecutive series of 102 patients. Methods Data were recorded from technical notes and operative records created immediately following each surgery case, in which the robotic system was used to guide pedicle screw placement. All cases were performed at the same hospital by a single surgeon. The majority of patients had spinal deformity and/or previous spine surgery. Each planned screw placement was classified as: (1) successful/ accurately placed screw using robotic guidance; (2) screw malpositioned using robot; (3) use of robot aborted and screw placed manually; (4) planned screw not placed as screw deemed non essential for construct stability. Data from each case were reviewed by two independent researchers to indentify the diagnosis, number of attempted robotic guided screw placements and the outcome of the attempted placement as well as complications or reasons for non-placement. Results Robotic-guided screw placement was successfully used in 95 out of 102 patients. In those 95 patients, 949 screws (87.5 % of 1,085 planned screws) were successfully implanted. Eleven screws (1.0 %) placed using the robotic system were misplaced (all presumably due to ''skiving'' of the drill bit or trocar off the side of the facet). Robotic guidance was aborted and 110 screws (10.1 %) were manually placed, generally due to poor registration and/or technical trajectory issues. Fifteen screws (1.4 %) were not placed after intraoperative determination that the screw was not essential for construct stability. The robot was not used as planned in seven patients, one due to severe deformity, one due to very high body mass index, one due to extremely poor bone quality, one due to registration difficulty caused by previously placed loosened hardware, one due to difficulty with platform mounting and two due to device technical issues. Conclusion Of the 960 screws that were implanted using the robot, 949 (98.9 %) were successfully and accurately implanted and 11 (1.1 %) were malpositioned, despite the fact that the majority of patients had significant spinal deformities and/or previous spine surgeries. ''Tool skiving'' was thought to be the inciting issue with the misplaced screws. Intraoperative anteroposterior and oblique fluoroscopic imaging for registration is critical and was the limiting issue in four of the seven aborted cases.

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“…Table 1 illustrates the variety of cadaveric studies that have been performed and their characteristics. 18,19,21,[25][26][27]38,40 Whereas many published studies consisted of 1-2 cadavers, Togawa et al 42 reported on the placement of lumbosacral pedicle screws, translaminar facet screws, and was assessed separately; they had all been placed successfully, with an overall average deviation of 1.03 ± 0.59 mm. In the translaminar facet instrumentation surgery, the overall average K-wire deviation was 1.05 ± 0.56 mm.…”

Section: Cadaveric Studies Of Robot-assisted Spine Surgerymentioning

confidence: 99%

Robotics and the spine: a review of current and ongoing applications

Shweikeh¹,

Amadio

Arnell³

et al. 2014

FOC

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T echnological advances have revolutionized spine surgery over the past 20 years. Many of these developments have been centered on the innovations of new technology implants and minimally invasive spine surgery. The goals of these improvements have been to balance the maintenance of a high degree of precision, to minimize risks of damage to neurovascular structures, to facilitate surgeon access and operating room dynamics, and to diminish harmful exposure to ionizing radiation in patients and the operative team. Because the risks associated with spine surgery are plentiful and limiting complications is imperative, implementing a robot-assisted technique has the potential to address many concerns associated with conventional surgery.Robotic systems have been used in multiple surgical disciplines including gynecology, urology, and general surgery. In the last decade we have seen the application of this technology to spine surgery. Robots can potentially help with all matters of spine surgery including the following: precision in spinal instrumentation, eliminating dural and neurovascular injuries, minimizing exposure to radiation, and improving operating room workflow. 5At the same time, the technology affords the surgeon a significant improvement in coordination, 3D visualization, and a reduction in fatigue, and it offers the patient a smaller incision, lower risk of infections, minimal muscle retraction and thus postoperative pain, and shortened length of hospital stay. 16 Apart from screw and rod insertion, the technology has been applied to other forms of spine operations and pathological conditions including tumor resections and ablations, vertebroplasties, and anesthetic blocks. This article provides an overview and update on the utility of robotics in spine surgery and spine biomechanics testing. MethodsUsing the National Library of Medicine search enRobotics and the spine: a review of current and ongoing applications Object. Robotics in the operating room has shown great use and versatility in multiple surgical fields. Robotassisted spine surgery has gained significant favor over its relatively short existence, due to its intuitive promise of higher surgical accuracy and better outcomes with fewer complications. Here, the authors analyze the existing literature on this growing technology in the era of minimally invasive spine surgery.Methods. In an attempt to provide the most recent, up-to-date review of the current literature on robotic spine surgery, a search of the existing literature was conducted to obtain all relevant studies on robotics as it relates to its application in spine surgery and other interventions.Results. In all, 45 articles were included in the analysis. The authors discuss the current status of this technology and its potential in multiple arenas of spinal interventions, mainly spine surgery and spine biomechanics testing.Conclusions. There are numerous potential advantages and limitations to robotic spine surgery, as suggested in published case reports and in retrospective and prosp...

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Bone-Mounted Miniature Robotic Guidance for Pedicle Screw and Translaminar Facet Screw Placement

Abstract: These results verify the system's accuracy and support its use for minimally invasive spine surgery in selected patients.

Cited by 79 publications

References 40 publications

Placement of pedicle screws in thoracic idiopathic scoliosis: a magnetic resonance imaging analysis of screw placement relative to structures at risk

Placement of pedicle screws in thoracic idiopathic scoliosis: a magnetic resonance imaging analysis of screw placement relative to structures at risk

Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients

Robotics and the spine: a review of current and ongoing applications

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