Evaluation of K-wireless robotic and navigation assisted pedicle screw placement in adult degenerative spinal surgery: learning curve and technical notes

Workflow and Efficiency of Robotic-Assisted Navigation in Spine Surgery

“…During this step, all required surgical instrumentation is registered and verified. Registration is usually performed once; however, additional registrations may be required for longer instrumentation constructs [1].…”

“…In an open posterior fusion, a posterior midline skin incision is typically made followed by dissection of paravertebral muscles away from the lumbar spine. For each procedure, the robotic mount is attached to the PSIS or spinous process reference clamp, and fluoroscopic imaging is colocalized with the software planning template [1]. Of note, PSIS pins can be placed either before or after exposure.…”

“…One should always take care to avoid reference pin placement that obstructs planned screw trajectories, as this can lead to prolonged surgical time and an inability to place screws with robotic/navigation assistance. Avrumova et al reported events such as obstructive reference pin placement, which occurred in 0.6% of all robotically placed screws [1]. As a result, planned trajectories could not be achieved for certain pedicle screws.…”

“…Following pedicle screw placement, patients may undergo an intraoperative scan with a 3D mobile C-arm (Ziehm Imaging GmBH, Nuremberg, Germany) [1]. C-arm images are taken intraoperatively before and after the procedure, in addition to 3D fluoroscopic imaging.…”

“…C-arm images are taken intraoperatively before and after the procedure, in addition to 3D fluoroscopic imaging. This 3D imaging provides additional confidence in screw positioning, as implants can be evaluated in the axial, sagittal, and coronal planes [1]. Ziehm does not produce navigation or robotic platforms for spine surgery, but their scanners are compatible with certain imaging and navigation systems [10].…”