Initial Intraoperative Experience with Robotic-Assisted Pedicle Screw Placement with Cirq® Robotic Alignment: An Evaluation of the First 70 Screws

Abstract

Background: Robot-guided spine surgery is based on a preoperatively planned trajectory that is reproduced in the operating room by the robotic device. This study presents our initial experience with thoracolumbar pedicle screw placement using Brainlab’s Cirq® surgeon-controlled robotic arm (BrainLab, Munich, Germany). Methods: All patients who underwent robotic-assisted implantation of pedicle screws in the thoracolumbar spine were included in the study. Our workflow, consisting of preoperative imagining, screw planning, intraoperative imaging with automatic registration, fusion of the preoperative and intraoperative imaging with a review of the preplanned screw trajectories, robotic-assisted insertion of K-wires, followed by a fluoroscopy-assisted insertion of pedicle screws and control iCT scan, is described. Results: A total of 12 patients (5 male and 7 females, mean age 67.4 years) underwent 13 surgeries using the Cirq® Robotic Alignment Module for thoracolumbar pedicle screw implantation. Spondylodiscitis, metastases, osteoporotic fracture, and spinal canal stenosis were detected. A total of 70 screws were implanted. The mean time per screw was 08:27 ± 06:54 min. The mean time per screw for the first 7 surgeries (first 36 screws) was 16:03 ± 09:32 min and for the latter 6 surgeries (34 screws) the mean time per screw was 04:35 ± 02:11 min (p < 0.05). Mean entry point deviation was 1.9 ± 1.23 mm, mean deviation from the tip of the screw was 2.61 ± 1.6 mm and mean angular deviation was 3.5° ± 2°. For screw-placement accuracy we used the CT-based Gertzbein and Robbins System (GRS). Of the total screws, 65 screws were GRS A screws (92.85%), one screw was a GRS B screw, and two further screws were grade C. Two screws were D screws (2.85%) and underwent intraoperative revision. There were no perioperative deficits. Conclusion: Brainlab’s Cirq® Robotic Alignment surgeon-controlled robotic arm is a safe and beneficial method for accurate thoracolumbar pedicle screw placement with high accuracy.

Association of robot-assisted techniques with the accuracy rates of pedicle screw placement: A network pooling analysis

“…In an initial trial of CIRQ® in a small number of patients, 97.1% of screws did not require intraoperative revision. 53 The Excelsius GPS system has the functions of intraoperative real-time imaging and automatic compensation of patient motion. 54 Vardiman et al.…”

Development and Clinical Trial of a New Orthopedic Surgical Robot for Positioning and Navigation

“…The orthopedic surgical robot has the advantages of safety, accuracy, less radiation, and a shorter learning curve, and more and more surgeons have begun to perform robot-assisted surgeries [ 17 ]. In spinal surgeries, robot assistance is often adopted for pedicle screw insertion, navigation, and positioning in vertebroplasty [ 18 , 19 , 20 , 21 , 22 ]. Therefore, the accuracy of robot navigation and positioning directly affects the quality of spinal surgeries.…”

Robotic Spine Surgery: Past, Present, and Future

“…However, after registration, when roughly aligned to the entry point of the planned trajectory, Cirq will automatically adapt to the planned preoperative trajectory. 23 K-wires will be implanted at that time followed by pedicle screw instrumentation. Brainlab's Loop-X Mobile Imaging Robot was FDA cleared in 2021 (Figures 12 and 13), and allows for flexible intraoperative imaging with robotic movement in six planes and compatibility with Cirq.…”