Robotic-Assisted Versus Conventional Posterior Lumbar Fusion—An Analysis of 90-Day Complications and Readmissions

Malik, Azeem Tariq; Drain, Joseph P.; Jones, Jeremy; Karnes, Jonathan; Brewster, James; Ryu, Robert; Singh, Varun; Kim, Jeffery; Khan, Safdar N.; Yu, Elizabeth

doi:10.1016/j.wneu.2021.05.072

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…There was a statistically significant difference in the mean operative time in the TINAVI group (97.0 ± 10.5 min) compared with the traditional surgery group (150.7 ± 13.8 min), and multiple pedicle screw placements could be completed at once with robotic assistance and also due to the certain proficiency in the operation of the robot at our institution before the study. Malik et al 15 conducted a study on the complications of robot-assisted spine surgery and showed that the incidence of complications was not increased with robotic assistance, which is consistent with our results, and no serious complications occurred in either group. Ruyu Zhao et al 17 found that the intraoperative bleeding rate, VAS scores, and NDI scores were lower and the incision length and length of hospital stay were shorter in the TINAVI robotic group than in the traditional surgery group.…”

Section: Discussionsupporting

confidence: 91%

“…The surgeon plans the screw implantation trajectory based on the surgical operation and planning system in the 3D mode. Subsequently, the robotic arm automatically calculates the spatial position of the planned trajectory and, together with the optical tracking system, moves precisely to the planned position and guides the surgeon in precisely placing the screw through the trocar with the help of a guide pin 15 . The optical tracking system consists of an infrared stereoscopic camera and two tracers (attached to the spinous process and used by the robotic arm for positioning), which cooperate with the robotic arm to achieve real-time motion compensation and ensure that the robotic arm accurately performs the intended trajectory.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine–Edward type IIA (postreduction) hangman fractures

Li,

Du,

Huang

et al. 2023

Sci Rep

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The objective was to compare the clinical efficacy of percutaneous pedicle screw internal fixation with the aid of the TINAVI orthopaedic surgery robot with that of traditional open surgery for Levine–Edward type IIA (postreduction) hangman fractures and to evaluate the safety and efficacy of the TINAVI robot-assisted orthopaedic surgery procedure. The clinical data of 60 patients with Levine–Edward type IIA (postreduction) hangman fractures treated surgically from June 2015 to February 2022 were analysed retrospectively. Among these patients, 25 were treated with percutaneous pedicle screw fixation under TINAVI (the robot group), and 35 were treated with pedicle screw implantation assisted by a conventional C-arm X-ray machine (the traditional operation group). The pedicle screw placement grade was evaluated according to the Rampersaud scale. The correct rate of pedicle screw placement was calculated. The invasion of adjacent facet joints, VAS score (Visual Analogue Scale), NDI score (Neck Disability Index), SF-36 score (36-Item Short-Form Health Survey questionnaire), EQ-5D score (EuroQol-5 dimensions questionnaire) and operation-related data were recorded, and patients were followed up. All patients were followed up for an average of 15.0 ± 3.4 months. The accuracy of screw placement in the robot group was higher than that in the traditional operation group, while the rates of intraoperative blood loss and invasion of the facet joint were lower and the incision length and length of hospital stay were shorter. On the 3rd day after the operation, the VAS score in the robot group was significantly higher than that in the traditional operation group, but there was no significant difference in the NDI score. On the 3rd day after the operation, the SF-36 and EQ-5 questionnaire scores of the robot group were better than those of the traditional operation group. No complications occurred in any of the patients. Postoperative cervical X-ray showed that the cervical vertebra was stable, and there was no fracture, angle or displacement. Postoperative CT showed that all fractures healed, and the average healing time was 3.4 months. The treatment of Levine–Edward IIA (postrepositioning) hangman fractures with percutaneous pedicle fixation assisted by the TINAVI orthopaedic surgery robot can significantly improve screw placement accuracy with a low rate of invasion of the adjacent facet joint, a short operation time, a low bleeding rate, and high patient satisfaction. Although there are still many disadvantages, it still has good prospects for application.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine–Edward type IIA (postreduction) hangman fractures

Li,

Du,

Huang

et al. 2023

Sci Rep

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“…Marcus et al identified several potential sources of bias when comparing robotic-guided and fluoroscopy-guided spine surgery: the selection bias (following the introduction of the robot into surgical practice, straightforward cases were selected in the first instance while the operating team was familiarizing themselves with the technique), for which there are potential confounders such as unbalanced age, sex and BMI, which are usually not taken into consideration, Most of the studies contained a mixed cohort of patients who underwent stabilization in the thoracic and lumbar spine and patients who underwent open and MIS surgery, whereby screw placement was not universally assessed and several grading systems were used [66]. A recent meta-analysis on 39,387 patients who underwent posterior lumbar fusion revealed that robotic-assisted fusion had similar rates of surgical and medical complications compared with those who underwent conventional fusion [67]. In contrast to this finding, Liounakos et al, in their single center evaluation of 374 robotic-guided and 111 fluoroscopy guided procedures, reported that robotic guidance was associated with significant reductions in postoperative complication rates at all follow-up time points and significant reductions in revision rates at 90 days and 1 year [68].…”

Section: Comparison Of Robotic-guided Spine Surgery With Fluoroscopy-guided and Navigation-guided Spine Surgerymentioning

confidence: 99%

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

Pojskić

Bopp

Nimsky

et al. 2021

JCM

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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.

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Robotic-Assisted Versus Navigation-Assisted Posterior Lumbar Fusion

Gouzoulis,

Seddio,

Winter

et al. 2024

Spine

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Study Design. Retrospective cohort study Objective. Compare perioperative adverse events and reoperations between navigation-assisted and robotic-assisted posterior lumbar fusion. Summary of Background data. Navigation has become increasingly utilized for posterior lumbar fusion (PLF). More recently, robotic assistance systems have been gaining traction. However, the incremental advantage of these systems has been unclear in the literature. Methods. Patients undergoing one to three level PLF (with or without anterior or posterior interbody fusion) were identified from the 2015–2022 M161Ortho PearlDiver Database using CPT codes. Navigation assistance was identified based on CPT coding and robotic assistance was based on ICD-10 procedural coding. Navigation-assisted cases were matched 4:1 to robotic assisted patients based on age, sex, Elixhauser Comorbidity Index, number of levels fuse, and concomitant anterior fusion. Incidence of 90-day adverse outcomes were assessed and compared with multivariable logistical regression. Bonferroni correction was applied for multiple testing. Rate of reoperation was assessed using a Kaplan-Meier survival analysis. Results. From 2015 to 2022, there has been a significant increase in both navigation and robotic assisted lumbar fusions, with navigation-assisted surgery being significantly more common. After matching, there were 2,401 navigation-assisted cases and 651 robotic-assisted cases. On multivariate analysis, there no significant differences in 90-day any, severe, or minor adverse events. There was a significant increase odd of readmissions in the robotic cohort (OR: 1.77, P<0.001). There were no differences in three-year reoperation rates between the navigation-assisted and robotic-assisted cohorts (95.8% versus 94.0%, P=0.30). Conclusions. As spinal navigation has been gaining popularity and robotic assistance is starting to be further utilized, the incremental advantage of different techniques may be questioned. While further study and technique evolution are ongoing, the current study was not able to demonstrate 90-day or 3-year incremental advantages for robotics relative to navigation based on the metrics evaluated.

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Robotic-Assisted Versus Conventional Posterior Lumbar Fusion—An Analysis of 90-Day Complications and Readmissions

Cited by 3 publications

References 14 publications

Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine–Edward type IIA (postreduction) hangman fractures

Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine–Edward type IIA (postreduction) hangman fractures

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

Robotic-Assisted Versus Navigation-Assisted Posterior Lumbar Fusion

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