Robotic-guided placement of cervical pedicle screws: feasibility and accuracy

Kisinde, Stanley; Hu, Xiaobang; Hesselbacher, Shea; Satin, Alexander M.; Lieberman, Isador H.

doi:10.1007/s00586-022-07110-4

Cited by 21 publications

(23 citation statements)

References 56 publications

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“…98 A recent retrospective study assessing robotic cervical pedicle screw placement utilizing the Mazor X found an overall trajectory deviation of 2.20 1.17 mm, deviating from the preoperative plan by 1.32 1.17 mm in the axial plane and 1.27 1.00 mm in coronal plane. 59 In this study, 15.9% of cervical pedicle screws had medial breaches less than 1 mm, with no clinical consequences. A prospective randomized controlled study utilizing the Tianji Robot (TINAVI Medical Technologies Co., Ltd., Beijing, China) found cervical pedicle instrumentation to have better screw placement accuracy compared with the conventional fluoroscopic-assisted group (0.83 [0.44, 1.29] mm vs. 1.79 [1.41, 2.50] mm, P < 0.001) (19).…”

Section: Cervical Instrumentationmentioning

confidence: 53%

“…28,[53][54][55][56] While instrumentation accuracy has been most rigorously studied for thoracic and lumbar pedicle screw placement, cervical pedicle screw and S2-alar-iliac screw (S2AI) placements have also been shown to be accurate and feasible with advanced technology. 17,[57][58][59] One prospective cohort analysis comparing robotic technology evolution between the Mazor Renaissance robot and the newer generation Mazor X robot found no difference in accuracy (Renaissance: 1.1% vs. X:1.3%, P = 0.786), time per screw (Renaissance: 4.6 min vs. X: 3.9 min, P = 0.246), radiation exposure, and non-robot related complications. 60 However, the newer generation Mazor X was found to be more reliable (abandonment rate of 2.3% vs. 22.7% for Renaissance, P = 0.007), and had significantly fewer S2AI screw placement breaches (X:1.2% vs. Renaisaance:9.5%, P = 0.025).…”

Section: Available Evidence Accuracymentioning

confidence: 99%

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Robotic Spine Surgery: Past, Present, and Future

Perfetti

Kisinde

Rogers-LaVanne

et al. 2022

Spine

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Study Design. Systematic review. Objective. The aim of this review is to present an overview of robotic spine surgery (RSS) including its history, applications, limitations, and future directions. Summary of Background Data. The first RSS platform received United States Food and Drug Administration approval in 2004. Since then, robotic-assisted placement of thoracolumbar pedicle screws has been extensively studied. More recently, expanded applications of RSS have been introduced and evaluated. Methods. A systematic search of the Cochrane, OVID-MEDLINE, and PubMed databases was performed for articles relevant to robotic spine surgery. Institutional review board approval was not needed. Results. The placement of thoracolumbar pedicle screws using RSS is safe and accurate and results in reduced radiation exposure for the surgeon and surgical team. Barriers to utilization exist including learning curve and large capital costs. Additional applications involving minimally invasive techniques, cervical pedicle screws, and deformity correction have emerged. Conclusion. Interest in RSS continues to grow as the applications advance in parallel with image guidance systems and minimally invasive techniques. IRB Approval. N/A.

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Section: Cervical Instrumentationmentioning

confidence: 53%

Section: Available Evidence Accuracymentioning

confidence: 99%

Robotic Spine Surgery: Past, Present, and Future

Perfetti

Kisinde

Rogers-LaVanne

et al. 2022

Spine

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“…This finding is consistent with the conclusions obtained from the comparative studies performed by Su et al, 14 Lyu et al, 15 and Zhan et al 16 However, the rates of cervical screw placement accuracy with RA methods varied widely ranging from 66.7% to 91.4% in the published literatures of comparative studies and case series. [13][14][15][16][17][18][19] In addition, the application of RA system on cervical spine surgery is still in its early developmental stage, and whether the RA techniques are safe and accurate in cervical screw placement remains controversial.…”

Section: Neurospine Eissn 2586-6591 Pissn 2586-6583mentioning

confidence: 99%

“…After duplicate elimination, 527 articles underwent title and abstract assessment, maintaining 16 studies for full-text screen- ing. Finally, 1 RCT, 13 3 comparative cohort studies, [14][15][16] and 3 case series [17][18][19] were included in our meta-analysis.…”

Section: Literature Searchmentioning

confidence: 99%

Robotics in Cervical Spine Surgery: Feasibility and Safety of Posterior Screw Placement

Zhou

Zhang

et al. 2023

Neurospine

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Objective: Robot-assisted (RA) techniques have been widely investigated in thoracolumbar spine surgery. However, the application of RA methods on cervical spine surgery is rare due to the complex morphology of cervical vertebrae and catastrophic complications. Thus, the feasibility and safety of RA cervical screw placement remain controversial. This study aims to evaluate the feasibility and safety of RA screw placement on cervical spine surgery.Methods: A comprehensive search on PubMed, Cochrane Library, Embase Database, Web of Science, Chinese National Knowledge Databases, and Wanfang Database was performed to select potential eligible studies. Randomized controlled trials (RCTs), comparative cohort studies, and case series reporting the accuracy of cervical screw placement were included. The Cochrane risk of bias criteria and Newcastle-Ottawa Scale criteria were utilized to rate the risk of bias of the included literatures. The primary outcome was the rate of cervical screw placement accuracy with robotic guidance; subgroup analyses based on the screw type and insertion segments were also performed.Results: One RCT, 3 comparative cohort studies, and 3 case series consisting of 160 patients and 719 cervical screws were included in this meta-analysis. The combined outcomes indicated that the rates of optimal and clinically acceptable cervical screw placement accuracy under robotic guidance were 88.0% (95% confidence interval [CI], 84.1%–91.4%; p = 0.073; I2 = 47.941%) and 98.4% (95% CI, 96.8%–99.5%; p = 0.167; I2 = 35.954%). The subgroup analyses showed that the rate of optimal pedicle screw placement accuracy was 88.2% (95% CI, 83.1%–92.6%; p = 0.057; I2 = 53.305%); the rates of optimal screw placement accuracy on C1, C2, and subaxial segments were 96.2% (95% CI, 80.5%–100.0%; p = 0.167; I2 = 44.134X%), 89.7% (95% CI, 80.6%–96.6%; p = 0.370; I2 = 0.000X%), and 82.6% (95% CI, 70.9%–91.9%; p = 0.057; I2 = 65.127X%;), respectively.Conclusion: RA techniques were associated with high rates of optimal and clinically acceptable screw positions. RA cervical screw placement is accurate, safe, and feasible in cervical spine surgery with promising clinical potential.

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“…Lateral mass fixation is almost always performed, but cervical pedicle screws are utilized in certain cases and can be safely placed with modern navigation and robotics platforms. 33 Laminoplasty is an excellent motion sparring option for a multilevel level or retrovertebral disease but necessitates appropriate patient selection. Assessment of the modified K-line is crucial in patients with OPLL and retrovertebral disease.…”

Section: Authors' Preferred Treatmentmentioning

confidence: 99%

Review of Prospective Trials for Degenerative Cervical Myelopathy

Satin

Rush²,

Derman³

2022

Clinical Spine Surgery: A Spine Publication

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Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults. DCM refers to a collection of degenerative conditions that cause the narrowing of the cervical canal resulting in neurological dysfunction. A lack of high-quality studies and a recent increase in public health awareness has led to numerous prospective studies evaluating DCM. Studies evaluating the efficacy of surgical intervention for DCM can be characterized by the presence (comparative) or absence (noncomparative) of a nonoperative control group. Noncomparative studies predominate due to concerns regarding treatment equipoise. Comparative studies have been limited by methodological issues and have not produced consistent findings. More recent noncomparative studies have established the safety and efficacy of surgical intervention for DCM, including mild myelopathy. The optimal surgical intervention for DCM remains controversial. A recent randomized clinical trial comparing dorsal and ventral techniques found similar improvements in patient-reported physical function at early follow-up. Recent prospective studies have enriched our understanding of DCM and helped guide current treatment recommendations.

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Robotic-guided placement of cervical pedicle screws: feasibility and accuracy

Cited by 21 publications

References 56 publications

Robotic Spine Surgery: Past, Present, and Future

Robotic Spine Surgery: Past, Present, and Future

Robotics in Cervical Spine Surgery: Feasibility and Safety of Posterior Screw Placement

Review of Prospective Trials for Degenerative Cervical Myelopathy

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