Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p>Recent studies have investigated the role of spinal image guidance for pedicle screw placement. Many authors have observed an elevated placement accuracy and overall improvement of outcome measures. This study assessed a bi-institutional experience following introduction of the Renaissance miniature robot for spinal image guidance in Europe.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The medical records and radiographs of all patients who underwent robot-guided implantation of spinal instrumentation using the novel system (between October 2011 and March 2015 in Mainz and February 2014 and February 2016 in Regensburg) were reviewed to determine the efficacy and safety of the newly introduced robotic system. Screw position accuracy, complications, exposure durations to intraoperative radiation, and reoperation rate were assessed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of the 413 surgeries that used robotic guidance, 406 were via a minimally invasive approach. In 7 cases the surgeon switched to conventional screw placement, using a midline approach, due to referencing problems. A total of 2067 screws were implanted using robotic guidance, and 1857 screws were evaluated by postoperative CT. Of the 1857 screws, 1799 (96.9%) were classified as having an acceptable or good position, whereas 38 screws (2%) showed deviations of 3–6 mm and 20 screws (1.1%) had deviations &gt; 6 mm. Nine misplaced screws, implanted in 7 patients, required revision surgery, yielding a screw revision rate of 0.48% of the screws and 7 of 406 (1.7%) of the patients. The mean ± SD per-patient intraoperative fluoroscopy exposure was 114.4 (± 72.5) seconds for 5.1 screws on average and any further procedure required. Perioperative and direct postoperative complications included hemorrhage (2 patients, 0.49%) and wound infections necessitating surgical revision (20 patients, 4.9%).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The hexapod miniature robotic device proved to be a safe and robust instrument in all situations, including those in which patients were treated on an emergency basis. Placement accuracy was high; peri- and early postoperative complication rates were found to be lower than rates published in other series of percutaneous screw placement techniques. Intraoperative radiation exposure was found to be comparable to published values for other minimally invasive and conventional approaches.</jats:p></jats:sec>

Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: an evaluation of the first 54 cases

“…Pedicle screw pullout strength decreases by up to 71% when the lateral wall is perforated, making accurate screw placement of utmost importance [3]. Robotic guidance with navigation assists surgeons in placing screws more consistently and accurately for posterior fixation of the spine [11][12][13][14]. The current study showed pedicle screw placement accuracy of 98%, based on GRS grading, for the first 52 patients or 292 screws placed with robotic guidance and navigation.…”

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

“…6,19,21,22,26,28,29,33 Both the guide tube and drill bit are designed to anchor at the bony entrance point of the screw; however, most entrance points for pedicle screws are on the slope of the lateral aspect of the facet joint. The increased facet slope in the upper thoracic spine 29 or due to facet joint hypertrophy 19 has been associated with skiving and subsequent screw misplacement; high drilling pressure is also associated with skiving. 33 While the current study used an intraoperative CT workflow to avoid the pitfalls of preoperative CT and the need for planar fluoroscopic registration, the investigated RAN system possesses several unique features to avoid the limitations of PRA motion and instrument skiving.…”

Initial Single-Institution Experience With a Novel Robotic-Navigation System for Thoracolumbar Pedicle Screw and Pelvic Screw Placement With 643 Screws

“…Most prior studies have been performed using SpineAssist or Renaissance (Mazor Robotics Ltd, Caesarea, Israel), and demonstrate accuracy rates between 96.7% and 98.9%. 10,11 The potential for perfecting accuracy is even higher when combining both navigation and robotics. Recently, there was 1 small case series published examining the use of ExcelsiusGPS in 2 patients, demonstrating 100% accuracy in screw placement in 8 screws.…”