Overview of Robotic Technology in Spine Surgery

Alluri, Ram K.; Avrumova, Fedan; Sivaganesan, Ahilan; Vaishnav, Avani S.; Lebl, Darren R.; Qureshi, Sheeraz A.

doi:10.1177/15563316211026647

Cited by 32 publications

(21 citation statements)

References 58 publications

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“…The increased accuracy of pedicle screws and decreased surgical risks has driven the advent of newer technologies, such as navigation and robotics, over the last two decades [12][13][14][15]. These modalities are based on 3D real-time image guidance and thus, have been reported to decrease the incidence of screw malposition.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted versus navigation-assisted screw placement in spinal vertebrae

Jiao

Wang

et al. 2022

International Orthopaedics (SICOT)

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Purpose Both robots and navigation are effective strategies for optimizing screw placement, as compared to freehand placement. However, few studies have compared the accuracy and efficiency of these two techniques. Thus, the purpose of this study is to compare the accuracy and efficiency of robotic and navigation-assisted screw placement in the spinal vertebrae. Methods The 24 spine models were divided into a robot- and navigation-assisted groups according to the left and right sides of the pedicle. The C-arm transmits image data simultaneously to the robot and navigates using only one scan. After screw placement, the accuracy of the two techniques were compared using “angular deviation” and “Gertzbein and Robbins scale” in different segments (C1–7, T1–4, T5–8, T9–12, and L1–S1). In addition, operation times were compared between robot- and navigation-assisted groups. Results Robots and navigation systems can simultaneously assist in screw placement. The robot-assisted group had significantly less angular deviation than the navigation-assisted group from C1 to S1 (p < 0.001). At the C1–7 and T1–4 segments, the robot-assisted group had a higher rate of acceptable screws than the robot-assisted group. However, at the T5–8, T9–12, and L1–S1 segments, no significant difference was found in the incidence of acceptable screws between the two groups. Moreover, robot-assisted screw placement required less operative time than navigation (p < 0.05). Conclusion The robot is more accurate and efficient than navigation in aiding screw placement. In addition, robots and navigation can be combined without increasing the number of fluoroscopic views.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted versus navigation-assisted screw placement in spinal vertebrae

Jiao

Wang

et al. 2022

International Orthopaedics (SICOT)

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“…On the other hand, first-generation robots and second-generation robots, analysed by the included studies, did not have integrated navigation and independent instrument navigation. Recent spine robots have a fully integrated navigation platform, allowing for real-time instrument tracking and pedicle screw placement without guidewires [34]. The data collected varied across studies; sometimes, the data were scarce and sometimes the units of measurement were different, so it is not possible to properly assess these findings.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of robotic spine surgery: systematic review and meta-analysis

et al. 2022

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Background Robotic surgery (RS) may offer benefits compared with freehand/conventional surgery (FS) in the treatment of patients with spinal disease. The aim of this study was to evaluate the efficacy and safety of RS versus FS in spinal fusion. Methods A systematic review and meta-analysis was performed. Data analysis and risk of bias assessment were analysed using REVMAN V5.3. Results We found 11 randomised clinical trials involving 817 patients (FS: 408, RS: 409). The main diagnosis was degenerative spine disease. SpineAssist, Renaissance (Mazor Robotics), Tianji Robot and TiRobot robots (TINAVI Medical Technologies) were used. Pedicle screw placement within the safety zone (grades A + B according to the Gertzbein and Robbins scale) ranged from 93% to 100% in FS versus 85–100% in RS (relative risk 1.01, 95% CI 1.00–1.03, p = 0.14). Regarding intervention time, the meta-analysis showed a mean difference (MD) of 6.45 min (95% CI −13.59 to 26.49, p = 0.53). Mean hospital stay was MD of −0.36 days (95% CI −1.03 to 0.31, p = 0.30) with no differences between groups. Contradictory results were found regarding fluoroscopy time, although there seems to be a lower radiation dose in RS versus FS (p < 0.05). Regarding safety, the studies included surgical revision frequency. Conclusions No conclusive results were found suggesting that there are benefits in using RS over FS for spinal fusion. Further research with adequate patient selection, robot type and quality-of-life variables is needed. Level of evidence: level 1.

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“…Current-generation robotics offers integrated navigation capability and K-wireless placement of pedicle screws through a rigid robotic arm. It also allows for planning and placement of the interbody device ( 10 , 18 ).…”

Section: Commentsmentioning

confidence: 99%

“…Advancements in navigation systems, surgical instruments, and surgical robots have considerably reduced the early difficulties, enabling the MI-TLIF to become the modern cornerstone of MI lumbar interbody fusions. Spine robots are among the latest innovations with a promising potential to refine and improve the TLIF technique ( 10 ). A challenge with adopting robotic-guided spine surgery is overcoming the initial learning curve associated with every new technique, and a key objective of this guide is to share technical pearls that enable surgeons to overcome this potential barrier sooner.…”

Section: Introductionmentioning

confidence: 99%

Step-by-step guide to robotic-guided minimally invasive transforaminal lumbar interbody fusion (MI-TLIF)

Sarmiento¹,

Shahi²,

Melissaridou³

et al. 2023

Ann Transl Med

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Robotics in spinal surgery offers a promising potential to refine and improve the minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) technique. Suitable surgeons for this technique include those who are already familiar with robotic-guided lumbar pedicle screw placement and want to advance their skillset by incorporating posterior-based interbody fusion. We provide a step-by-step guide for robotic-guided MI-TLIF. The procedure is divided into 7 practical and detailed techniques. The steps in sequential order include: (I) planning trajectories for pedicle screws and the tubular retractor; (II) robotic-guided pedicle screw placement; (III) placement of tubular retractor; (IV) unilateral facetectomy using the surgical microscope; (V) discectomy & disc preparation; (VI) interbody implant insertion; and(VII) percutaneous rod placement. We standardize surgeon training in robotic MI-TLIF by teaching our spine surgery fellows these 7 key technical steps highlighted in this guide. Current-generation robotics offers integrated navigation capability, K-wireless placement of pedicle screws through a rigid robotic arm, compatibility with tubular retractor systems to perform facetectomy, and allows for placement of interbody devices. We have found robotic-guided MI-TLIF to be a safe procedure that allows for accurate and reliable pedicle screw placement, less collateral damage to the soft tissues of the low back, and decreased radiation exposure.

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Overview of Robotic Technology in Spine Surgery

Cited by 32 publications

References 58 publications

Robot-assisted versus navigation-assisted screw placement in spinal vertebrae

Robot-assisted versus navigation-assisted screw placement in spinal vertebrae

Efficacy and safety of robotic spine surgery: systematic review and meta-analysis

Step-by-step guide to robotic-guided minimally invasive transforaminal lumbar interbody fusion (MI-TLIF)

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