Minimally Invasive Robot-Guided Dual Cortical Bone Trajectory for Adjacent Segment Disease

Rho, Kyungduk; O’Connor, Timothy E.; Lucas, Jean-Marc P; Pollina, John; Mullin, Jeffrey P.

doi:10.7759/cureus.16822

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…Melikian et al [ 87 ] published a case report on unilateral cortical trajectory screw instrumentation, allowing for posterior instrumentation without having to remove the existing PSs in the setting of ASD. Rho et al [ 88 ] first applied robotic placement of a CBT screw in the same pedicle as a prior traditional PS for ASD.…”

Section: Advantages Of Midlf In Spinal Revision Surgerymentioning

confidence: 99%

Application of the cortical bone trajectory technique in posterior lumbar fixation

Peng¹,

Yuan²,

Lu³

et al. 2023

World J Clin Cases

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The cortical bone trajectory (CBT) is a novel technique in lumbar fixation and fusion. The unique caudocephalad and medial-lateral screw trajectories endow it with excellent screw purchase for vertebral fixation via a minimally invasive method. The combined use of CBT screws with transforaminal or posterior lumbar interbody fusion can treat a variety of lumbar diseases, including spondylolisthesis or stenosis, and can also be used as a remedy for revision surgery when the pedicle screw fails. CBT has obvious advantages in terms of surgical trauma, postoperative recovery, prevention and treatment of adjacent vertebral disease, and the surgical treatment of obese and osteoporosis patients. However, the concept of CBT internal fixation technology appeared relatively recently; consequently, there are few relevant clinical studies, and the long-term clinical efficacy and related complications have not been reported. Therefore, large sample and prospective studies are needed to further reveal the long-term complications and fusion rate. As a supplement to the traditional pedicle trajectory fixation technique, the CBT technique is a good choice for the treatment of lumbar diseases with accurate screw placement and strict indications and is thus deserving of clinical recommendation.

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Section: Advantages Of Midlf In Spinal Revision Surgerymentioning

confidence: 99%

Application of the cortical bone trajectory technique in posterior lumbar fixation

Peng¹,

Yuan²,

Lu³

et al. 2023

World J Clin Cases

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“…CBT screws are particularly suitable for use in revision surgery because CBT screws have special screw structure (small diameter and length, with tight threads) and can be inserted from the inner and inferior aspects to the outer and superior aspects through the pedicle, which allows close screw contact with cortical bone of the pedicle, and results in low rate of FJV [ 16 , 35 ]. Rho et al [ 36 ] reported the use of RA CBT screw placement using Mazor X robot in the treatment of a patient with adjacent segment degeneration after thoracolumbar surgery, they inserted CBT screw again in the same pedicle without removal of the original pedicle screw, the results showed that bilateral screw placement was completed successfully, without the occurrence of bony destruction, RA CBT screw placement was more minimally invasive and had shorter hospital stay when compared to traditional revision surgery. Zhang et al [ 28 ] conducted a retrospective study on 81 patients who underwent lumbar spine revision surgery via a posterior approach, 39 patients received pedicle screw placement using Mazor Renaissance, the remaining 42 patients received conventional FH pedicle screw placement, they found that the number of screws inserted was 267 in the Mazor Renaissance group and 288 in the conventional FH group, lumbar pedicular screw placement accuracy was 93% in the Mazor Renaissance group, and 87.1% in the conventional FH group.…”

Section: Clinical Application Scenarios For Spine Surgical Robotsmentioning

confidence: 99%

Spine Surgical Robotics: Current Status and Recent Clinical Applications

Wang,

Miao,

Zhan

et al. 2023

Neurospine

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With the development of artificial intelligence and the further deepening of medical-engineering integration, spine surgical robot-assisted (RA) technique has made significant progress and its applicability in clinical practice is constantly expanding in recent years. In this review, we have systematically summarized the majority of literature related to spine surgical robots in the past decade, and not only classified robots accordingly, but also summarized the latest research progress in RA technique for screw placement such as cervical, thoracic, and lumbar pedicle screws, cortical bone trajectory screws, cervical lateral mass screws, and S2 sacroiliac screws; guiding targeted puncture and placement of endoscope via the intervertebral foramen; complete resection of spinal tumor tissue; and decompressive laminectomy. In addition, this report also provides a detailed evaluation of RA technique’s advantages and disadvantages, and clarifies the accuracy, safety, and practicality of RA technique. We consider that this review can help clinical physicians further understand and familiarize the current clinical application status of spine surgical robots, thereby promoting the continuous improvement and popularization of RA technique, and ultimately benefiting numerous patients.

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“…As robotic spinal surgery has become widely used, the advantages of a relatively short learning curve, high accuracy of robot-assisted screw placement, and short radiation exposure time have been highlighted. [8][9][10][11][12] In view of this, this study presented an analysis of the clinical data of 7 cases treated by the CBT screw fixation technique as a salvage strategy with the help of the Mazor Renaissance robot system to evaluate the therapeutic effect of this technique for failed lumbar spine surgery.…”

Section: Introductionmentioning

confidence: 99%

The Cortical Bone Trajectory Screw Technique Assisted by the Mazor Renaissance Robotic System as a Salvage Strategy for Failed Lumbar Spine Surgery: Technical Note and Case Series

Han,

Guo,

et al. 2023

JPR

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Purpose The objective of this study was to describe the Mazor Renaissance robotic system-assisted CBT (cortical bone trajectory) screw technique as a salvage strategy for failed lumbar spine surgery. Patients and Methods Between January 2018 and June 2022, 7 patients underwent salvage surgery with the CBT screw fixation technique assisted by the Mazor Renaissance robot system in our institution. Intraoperative observations were recorded for blood loss, duration of operation, and fluoroscopy time. Complications related to CBT screws were also recorded. The accuracy of CBT screws was recorded in accordance with the modified Gertzbein-Robbins classification. The JOA (Japanese Orthopedic Association) score for low back pain was used to evaluate surgical outcomes. Results A total of 26 CBT screws were placed in 7 patients, including 4 females and 3 males. Three patients underwent ASD (adjacent segment disease) and four patients underwent lumbar union failure with loose or compromised PSs (pedicle screws). The mean operation time was 129.29 ± 32.97 minutes, the mean blood loss was 180 ± 52.60 mL, and the mean intraoperative fluoroscopy time was 14.29 ± 3.15 s. All screws were clinically acceptable according to the Gertzbein-Robbins classification. There were no complications related to CBT screws in any of the cases. The JOA scores for low back pain of all patients were significantly improved at the final follow-up. Conclusion The CBT screw fixation technique supplemented the traditional PS fixation technique, which can be performed as a salvage strategy for failed lumbar spine surgery and achieved good clinical results. The spinal robot was very helpful in evaluating pedicle size and determining CBT screw direction, especially in a previously instrumented lumbar pedicle.

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Minimally Invasive Robot-Guided Dual Cortical Bone Trajectory for Adjacent Segment Disease

Cited by 5 publications

References 16 publications

Application of the cortical bone trajectory technique in posterior lumbar fixation

Application of the cortical bone trajectory technique in posterior lumbar fixation

Spine Surgical Robotics: Current Status and Recent Clinical Applications

The Cortical Bone Trajectory Screw Technique Assisted by the Mazor Renaissance Robotic System as a Salvage Strategy for Failed Lumbar Spine Surgery: Technical Note and Case Series

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