Robotic navigation during spine surgery

Zhang, Qi; Han, Xiaoguang; Xu, Yu; Fan, Mingxing; Zhao, Jingwei; Liu, Yajun; He, Da; Tian, Wei

doi:10.1080/17434440.2020.1699405

Cited by 63 publications

(49 citation statements)

References 54 publications

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“…In recent years, robot techniques have been introduced to the field of spinal surgery [ 18 ]. The accuracy rate of robot-assisted pedicle screw placement was over 98%, which could evidently reduce the incidence of complications [ 19 – 21 ]. Therefore, robot-assisting techniques could also be used to reduce the risk of screw-related complications.…”

Section: Discussionmentioning

confidence: 99%

Esophageal perforation following pedicle screw placement for the treatment of upper thoracic spinal tuberculosis: a case report and review of the literature

Wang

Hao

Qian

et al. 2020

BMC Musculoskelet Disord

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Background The technique of posterior pedicle screw fixation has already been widely applied in the treatment of upper thoracic spinal tuberculosis. However, lesions of tuberculosis directly invade the vertebrae and surrounding soft tissues, which increases the risk of esophageal perforation induced by the posterior pedicle screw placement. Herein, we report the first case of esophageal perforation following pedicle screw placement in the upper thoracic spinal tuberculosis, and describe the underlying causes, as well as the treatment and prognosis. Case presentation A 48-year-old female patient with upper thoracic spinal tuberculosis presented sputum-like secretions from the wound after she was treated with one-stage operation through the posterolateral approach. Endoscopy was immediately conducted, which confirmed that the patient complicated with postoperative esophageal perforation caused by screws. CT scan showed that the right screw perforated the anterior cortex of the vertebrae and the esophagus at the T4 level. Fortunately, mediastinal infection was not observed. The T4 screw was removed, Vacuum Sealing Drainage (VSD) was performed, and jejunum catheterization was used for enteral nutrition. After continuous treatment with sensitive antibiotics for 2.5 months and 5 times of VSD aspiration, the infected wound recovered gradually. With 18-month follow-up, the esophagus healed well, without symptoms of dysphagia and stomach discomfort, and CT scan showed that T2–4 had complete osseous fusion without sequestrum. Conclusion Tuberculosis increases the risk of postoperative esophageal perforation in a certain degree for patients with upper thoracic tuberculosis. The damages to esophagus during the operation should be prevented. The screws with the length no more than 30 mm should be selected. Moreover, close monitoring after operation should be conducted to help the early identification, diagnosis and treatment, which could help preventing the adverse effects induced by the delayed diagnosis and treatment of esophageal perforation.

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Section: Discussionmentioning

confidence: 99%

Esophageal perforation following pedicle screw placement for the treatment of upper thoracic spinal tuberculosis: a case report and review of the literature

Wang

Hao

Qian

et al. 2020

BMC Musculoskelet Disord

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“…The robotic spine surgery, as an innovation, has introduced many technologies, such as optical navigation and planning programs 41 . The intelligent algorithms can automatically and accurately navigate the screw placement, and their high accuracy can avoid repeated fluoroscopy 40 . Besides, most previous clinical trials focused on lumbar vertebral, and the skills and experience of surgeons in operating at the lumbar level also contributed to a better performance of the robots, which lowered the radiation dose.…”

Section: Discussionmentioning

confidence: 99%

“…Hyun et al reported that the fluoroscopy use among Mazor RA MIS patients was significantly reduced after the first 15 cases were evaluated 26 . Besides, Mazor robotic system relies on preoperative scans for screws planning while the other two are image‐guided devices that rely on the intraoperative 3D C‐arm scan for planning 15,40 . The latter approach may generate more accurate scans but require more fluoroscopy time.…”

Section: Discussionmentioning

confidence: 99%

“…26 Besides, Mazor robotic system relies on preoperative scans for screws planning while the other two are image-guided devices that rely on the intraoperative 3D C-arm scan for planning. 15,40 The latter approach may generate more accurate scans but require more fluoroscopy time. Furthermore, Lonjon and colleagues attributed the increase in radiation time to an increased number of radiographic images, which was averagely 5.3 per patient, whereas normally only two (anterior-posterior and lateral) are required for accurate image matching in the ROSA group.…”

Section: Radiation Exposurementioning

confidence: 99%

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The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

Fang

Jin

et al. 2020

Robotics Computer Surgery

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Background: Medical robotics has enabled a significant advancement in the field of modern spine surgery, especially in pedicle screw fixation. A plethora of studies focused on the accuracy of pedicle fixation in robotic-assisted (RA) technology. However, it is not clear whether RA techniques can improve patients' clinical outcomes. Methods: We retrieved relevant studies that compare the differences between RA and freehand (FH) techniques in spine surgeries from the following databases: PubMed, Embase, Cochrane Library and Web of Science. The perioperative outcomes of this technology were measured with parameters including radiation exposure, operative time, the length of hospital stay, complication rates and revision rates. Two reviewers independently reviewed the studies in our sample, assessed their validity and extracted relevant data. Results: Our search resulted in a sample of 23 eligible studies, which involved 1247 patients (5042 pedicle screws) in the RA group and 1273 patients (4830 pedicle screws) in the FH group. With regard to the radiation exposure, the fluoroscopy time was less in surgeries assisted by Mazor robots (standard mean difference [SMD] ¼ À 0.96, 95% CI ¼ À 1.60 to À 0.31) but more in Tianji robots (SMD ¼ 0.91, 95% CI ¼ 0.17 to 1.66) and ROSA robots (SMD ¼ 2.57, 95% CI ¼ 2.01 to 3.13). For radiation dose, a decrease was observed in Tianji robots (SMD ¼ À 1.59, 95% CI ¼ À 2.13 to À 1.05). In the lumbar subgroup, the use of robots increased the operative time (SMD ¼ 0.53, 95% CI ¼ 0.19 to 0.86). In the degenerative diseases (DG) group, there was a significant decrease in the length of hospital stay when robots were introduced (SMD ¼ À 0.30, 95% CI ¼ À 0.48 to À 0.12). While in the DF (deformity) and DG group, a significant increase was found (SMD ¼ 0.17, 95% CI ¼ 0.02 to 0.32). The complication (OR ¼ 0.41, 95% CI ¼ 0.26 to 0.66) and the revision rates (OR ¼ 0.38, 95% CI ¼ 0.24 to 0.60) showed a significant decrease in the RA group compared to the conventional FH group. Conclusions: This study suggests that RA spine surgeries would result in fewer complications, a lower revision rate and shorter length of hospital stay. As the technology continues to evolve, we may expect more applications of robotic systems in spine surgeries. Junyu Li and Yanming Fang contributed equally to this work.

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“…These studies compared robot-assisted surgery procedure with traditional surgical procedure and reported good clinical outcomes. In addition, Tian et al practiced Tirobot system in spinal surgery procedures, such as pedicle screw implantation, and achieved good results [12,13]. Nevertheless, the robotic surgery system has made great contributions to the translation from basic science to clinical science [14,15].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Tirobot-assisted Vertebroplasty in Treating Thoracolumbar Osteoporotic Compression Fracture

Wang

Cao

Chang

et al. 2020

Preprint

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Background: Percutaneous kyphoplasty is the main method for the treatment of thoracolumbar osteoporotic compression fractures. However, much radiation exposure during the operation could harm the health of the surgeon and the patient. In addition, the accuracy of its surgery still needs to be improved. This study aimed to assess the radiation exposure and clinical efficacy of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture.Methods: A total of 60 patients with thoracolumbar osteoporotic compression fracture who underwent unilateral vertebroplasty at our hospital between June 2019 and June 2020 were included in this retrospective cohort study. All of them were between 60 and 90 years old and free of systemic diseases. All the patients were assigned to Tirobot group (treated with Tirobot-assisted approach) and control group (treated with traditional approach). Fluoroscopic frequency, operative duration, length of stay (LOS), post-operative complications (cement leakage, infection, and thrombosis), pre-operative and pre-discharge indexes (VAS scores, JOA scores, and Cobb’s angles) were compared.Results: The fluoroscopic frequency(P<0.001), post-operative complications(P=0.035) in Tirobot group was significantly lower than those in control group. The operative duration and LOS in Tirobot group were shorter than those in control group, but the differences were not statistically significant (P=0.183). Pre-discharge VAS score and Cobb’s angle decreased, and JOA increased after surgeries in both groups. These three indexes showed significant differences after surgery in each group (P<0.001), but not between groups (PVAS=0.175, PCobb’s=0.585, PJOA =0.448).Conclusion: As a safe and effective strategy, Tirobot-assisted vertebroplasty can reduce radiation exposure and be clinically replicated.

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Robotic navigation during spine surgery

Cited by 63 publications

References 54 publications

Esophageal perforation following pedicle screw placement for the treatment of upper thoracic spinal tuberculosis: a case report and review of the literature

Esophageal perforation following pedicle screw placement for the treatment of upper thoracic spinal tuberculosis: a case report and review of the literature

The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

Effectiveness of Tirobot-assisted Vertebroplasty in Treating Thoracolumbar Osteoporotic Compression Fracture

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