Quantitative comparison of a laterally misplaced pedicle screw with a re-directed screw. How much pull-out strength is lost?

Korkmaz, Murat; Sariyilmaz, Kerim; Özkunt, Okan; Gemalmaz, Halil Can; Akgül, Turgut; Sungur, Mustafa; Dikici, Fatih; Baydoğan, Murat

doi:10.1016/j.aott.2018.03.002

Cited by 11 publications

(15 citation statements)

References 30 publications

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“…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].…”

Section: Discussionmentioning

confidence: 99%

“…Originally, screws were inserted via the freehand technique, which presents the risk of misplacement. Misplaced screws are not only biomechanically disadvantageous but also carry an increased risk for neurological deficit, vascular damage, and morbidity [1][2][3]. Advances in imaging and navigation such as fluoroscopic guidance have improved the accuracy of screw placement in the spine, yet significantly increased the amount of radiation exposure to the patient, surgeon, and operating room (OR) staff [4,5].…”

Section: Introductionmentioning

confidence: 99%

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

Benech¹,

Perez²,

Benech³

et al. 2019

J Robotic Surg

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Computer-aided navigation and robotic guidance systems have become widespread in their utilization for spine surgery. A recent innovation combines these two advances, which theoretically provides accuracy in spinal screw placement. This study describes the cortical and pedicle screw accuracy for the first 54 cases where navigated robotic assistance was used in a surgical setting. This is a retrospective chart review of the initial 54 patients undergoing spine surgery with pedicle and cortical screws using robotic guidance with navigation. A computed tomography (CT)-based Gertzbein and Robbins System (GRS) was used to classify pedicle screw accuracy. Screw tip, tail, and angulation offsets were measured using image overlay analysis. Screw malposition, reposition, and return to operating room rates were collected. 1 of the first 54 cases was a revision surgery and was excluded from the study. Ten screws were placed without the robot due to surgeon discretion and were excluded for the data analysis of 292 screws. Only 0.68% (2/292) of the robot-assisted screws was repositioned based on surgeon discretion. Based on the GRS CT-based grading, 98.3% (287/292) were graded A or B, 1.0% (3/292) screws were graded C, and only 0.7% (2/292) screws was graded D. The average offset from preoperative plan to actual final placement was 1.9 mm from the tip, 2.3 mm from the tail, and 2.8° of angulation. In the first 53 cases, 292 screws placed with navigated robotic assistance resulted in a high level of accuracy (98.3%), adequate screw offsets from planned trajectory, and zero complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Benech¹,

Perez²,

Benech³

et al. 2019

J Robotic Surg

View full text Add to dashboard Cite

show abstract

“…It is well known that screw misplacement has unpredictable clinical consequences for the patient. Reoperation or removal of the screw not only increases the patient's financial burden and the pressure on the doctor but also leads to unnecessary waste of medical resources [4]. Therefore, it is very important to enhance the accuracy rate of pedicle screw placement using auxiliary equipment.…”

Section: Introductionmentioning

confidence: 99%

Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis

Xie

et al. 2020

J Orthop Surg Res

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Background: Many surgeons believe that the use of a 3D-printed drill guide template shortens operative time and reduces intraoperative blood loss compared with those of the free-hand technique. In this study, we investigated the effects of a drill guide template on the accuracy of pedicle screw placement (the screw placed completely in the pedicle), operative time, and intraoperative blood loss. Materials/Methods: We systematically searched the major databases, such as Medline via PubMed, EMBASE, Ovid, Cochrane Library, and Google Scholar, regarding the accuracy of pedicle screw placement, operative time, and intraoperative blood loss. The χ 2 test and I 2 statistic were used to examine heterogeneity. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to calculate the accuracy rate of pedicle screw placement, and weighted mean differences (WMDs) with 95% CIs were utilized to express operative time and intraoperative blood loss. Results: This meta-analysis included 13 studies (seven randomized controlled trials and six prospective cohort studies) involving 446 patients and 3375 screws. The risk of research bias was considered moderate. Operative time (WMD = − 20.75, 95% CI − 33.20~− 8.29, P = 0.001) and intraoperative blood loss (WMD = − 106.16, 95% CI − 185.35 − 26.97, P = 0.009) in the thoracolumbar vertebrae, evaluated by a subgroup analysis, were significantly different between groups. The 3D-printed drill guide template has advantages over the free-hand technique and improves the accuracy of pedicle screw placement (OR = 2.88; 95% CI, 2.39~3.47; P = 0.000). Conclusion: The 3D-printed drill guide template can improve the accuracy rate of pedicle screw placement, shorten operative time, and reduce intraoperative blood loss.

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“…Whereas, the robotic assistance could reduce manual errors and perform repetitive work without fatigue [36]. What is more, the high one-time success rate of pedicle screw placement suggested that the RA technique could not only increase the pullout strength of screws, but also save time for readjustment of the screw position, leading to less damage to the pedicle, facet joint and soft tissue [37,38]. Given that intraoperative screw revision could affect the integrity of screw trajectory, the high one-time success rate of screw insertion was often appreciated due to higher pullout strength and lower risk of internal fixation failure [39,40].…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a retrospective matched-control analysis for clinical and quality-of-life outcomes

et al. 2021

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Aim: To compare the screw accuracy and clinical outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) and open TLIF in the treatment of one-level lumbar degenerative disease. Materials & methods: From May 2018 to December 2019, a consecutive series of patients undergoing robot-assisted minimally invasive one-level lumbar fusion procedures were retrospectively compared with matched controls who underwent one-level open TLIF procedures for clinical and quality-of-life outcomes. Results: A total of 52 patients underwent RA MIS-TLIF procedures (robot-assisted [RA] group) and 52 matched controls received freehand open TLIF procedures (open [OP] group). The RA group had more grade A screws with 96.2% one-time success rate of screw placement (p < 0.05). Besides, the RA group experienced less intraoperative blood loss and shorter length of hospital stay, while the OP group had shorter operative duration and cumulative radiation time (p < 0.001). What is more, the average VAS score for low back pain and ODI score in the RA group were lower than that in the OP group 1 month after operation (p < 0.05). Conclusion: The use of real-time, image-guided robot system may further expand the advantages of MIS-TLIF technique in terms of accuracy and safety.

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Quantitative comparison of a laterally misplaced pedicle screw with a re-directed screw. How much pull-out strength is lost?

Abstract: The results of this study confirm that pullout strength of pedicle screw decreases by approximately 71% when the lateral wall is perforated and decreases 28% after redirection to the accurate position.

Cited by 11 publications

References 30 publications

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

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

Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis

Robot-assisted minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a retrospective matched-control analysis for clinical and quality-of-life outcomes

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