Robotics in spine surgery: systematic review of literature

Lopez, Ignacio Barrio; Benzakour, Ahmed; Mavrogenis, Andreas F.; Benzakour, Thami; Ahmad, Alaaeldin Azmi; Lemée, Jean‐Michel

doi:10.1007/s00264-022-05508-9

Cited by 41 publications

(20 citation statements)

References 71 publications

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“…In our study, the incidence of unacceptable screws in our sample (10.8%) was consistent with other studies 3,4,[16][17][18][19] , which used the Gertzbein-Robbins scale for measuring accuracy 8 . However, our data added new insights when labelling implants as inaccurate.…”

Section: Discussionsupporting

confidence: 91%

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The pedicle screw accuracy using a robotic system and measured by a novel 3-dimensional method

Oppermann,

Karapetyan,

Gupta

et al. 2023

Preprint

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Robotics in medicine is associated with precision, accuracy, and replicability. Several robotic systems are used in spine surgery. They are all considered shared-control systems, providing "steady-hand" manipulation instruments. Although numerous studies have testified to the benefits of robotic instrumentations, they must address their true accuracy. Our study used the Mazor system under several situations and compared the spatial accuracy of the pedicle screw (PS) insertion and its planned trajectory. We used two cadaveric specimens with intact spinal structures from C7 to S1. PS planning was performed using the two registration methods (preopCT/C-arm or CT-to-fluoroscopy registration). After planning, the implant spatial orientation was defined based on six anatomic parameters using axial and sagittal CT images. Two surgical open and percutaneous access were used to insert the PS. After that, another CT acquisition was taken. Accuracy was classified into optimal, inaccurate and unacceptable according to the degree of screw deviation from its planning using the same spatial orientation method. Based on the type of spatial deviation, we also classified the PS trajectory into 16 pattern errors. Seven (19%) out of 37 implanted screws were considered unacceptable (deviation distances >2.0 mm or angulation >5°), and 14 (38%) were inaccurate ( >0.5 mm and ≤ 2.0 mm or >2.5º and ≤ 5º). CT-to-fluoroscopy registration was superior to preopCT/C-arm (average deviation in 0.9mm vs. 1.7mm, respectively, p<0.003), and percutaneous was slightly better than open but did not reach significance (1.3mm vs. 1.7mm, respectively). Regarding pattern error, the tendency was to have more axial than sagittal shifts. Using a quantitative method to categorize the screw 3D position, only 10.8% of the screws were considered unacceptable. However, with a more rigorous concept of inaccuracy, almost half were non-optimal. We also identified that, unlike some previous results, the O-arm registration delivers more accurate implants than the preopCT/C-arm method.

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Section: Discussionsupporting

confidence: 91%

“…Numerous studies have addressed the bene ts of robotics over other insertion techniques by linking the extent and rates of screw breaching [2][3][4] . Still, none have focussed on how accurate the nal trajectory is relative to its planning.…”

Section: Introductionmentioning

confidence: 99%

The pedicle screw accuracy using a robotic system and measured by a novel 3-dimensional method

Oppermann,

Karapetyan,

Gupta

et al. 2023

Preprint

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“…Even more recent is the advent of augmented reality and machine learning applications for the use of pedicle screw insertion, including the use of 3D printed technologies [6][7][8]. Since their inception, these technology-driven advanced approaches have been increasingly adopted amongst neurosurgical and orthopedic fields [9]. These technologies are aimed at improving screw placement accuracy and procedure time while simultaneously decreasing invasiveness of surgery [7,10], further, studies have shown improved complication profiles of patients undergoing pedicle screw placement, especially with more recent advanced technology-including a lower risk-profile for surgeons performing these operations [7,9].…”

Section: Robotic Pedicle Screw Placementmentioning

confidence: 99%

“…Since their inception, these technology-driven advanced approaches have been increasingly adopted amongst neurosurgical and orthopedic fields [9]. These technologies are aimed at improving screw placement accuracy and procedure time while simultaneously decreasing invasiveness of surgery [7,10], further, studies have shown improved complication profiles of patients undergoing pedicle screw placement, especially with more recent advanced technology-including a lower risk-profile for surgeons performing these operations [7,9]. Notwithstanding increased costs associated with initial adoption of these advanced technologies, steep learning curve, and potential for technical malfunctions, pedicle screw insertion using these new technologies and approaches are becoming increasingly prevalent and show cost-effectiveness long-term due to less revision, lower infection rates, reduced length of stay, and shorter operation time [9,11].…”

Section: Robotic Pedicle Screw Placementmentioning

confidence: 99%

Innovation in Neurosurgery: Lessons Learned, Obstacles, and Potential Funding Sources

Lucke‐Wold¹

2022

NND

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Innovation is central to neurosurgery and has dramatically increased over the last twenty years. Although the specialty innovates as a whole, only 3-4.7% of practicing neurosurgeons hold patents. Various roadblocks to innovation impede this process such as lack of understanding, increasing regulatory complexity, and lack of funding. Newly emerging technologies allow us to understand how to innovate and how to learn from other medical specialties. By further understanding the process of innovation, and the funding that supports it, Neurosurgery can continue to hold innovation as one of its’s central tenets.

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“…The majority of the extant literature on spinal robotics has merely focused on the accuracy of pedicle screw instrumentation or on short-term outcomes (e.g., hospital length of stay, intraoperative blood loss) in short segment fusion for degenerative disease. 14 The objective of the present report is to highlight the application of spinal robotics to the MIS correction of a patient with adult degenerative scoliosis (ADS). While it has been demonstrated that MIS deformity correction is associated with less pain, reduced narcotics usage, and shorter hospital stay, 5 the present case is, to our knowledge, the first description of the application of spinal robotics and planning for complex 11-level MIS ADS correction utilizing a multiple rod construct (MRC) with multipelvic fixation.…”

mentioning

confidence: 99%

Robotics planning in minimally invasive surgery for adult degenerative scoliosis: illustrative case

Pennington

Brown

Quadri

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Minimally invasive surgical techniques are changing the landscape in adult spinal deformity (ASD) surgery, enabling surgical correction to be achievable in increasingly medically complex patients. Spinal robotics are one technology that have helped facilitate this. Here the authors present an illustrative case of the utility of robotics planning workflow for minimally invasive correction of ASD. OBSERVATIONS A 60-year-old female presented with persistent and debilitating low back and leg pain limiting her function and quality of life. Standing scoliosis radiographs demonstrated adult degenerative scoliosis (ADS), with a lumbar scoliosis of 53°, a pelvic incidence–lumbar lordosis mismatch of 44°, and pelvic tilt of 39°. Robotics planning software was utilized for preoperative planning of the multiple rod and 4-point pelvic fixation in the posterior construct. LESSONS To the authors’ knowledge, this is the first report detailing the use of spinal robotics for complex 11-level minimally invasive correction of ADS. Although additional experiences adapting spinal robotics to complex spinal deformities are necessary, the present case represents a proof-of-concept demonstrating the feasibility of applying this technology to minimally invasive correction of ASD.

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Robotics in spine surgery: systematic review of literature

Cited by 41 publications

References 71 publications

The pedicle screw accuracy using a robotic system and measured by a novel 3-dimensional method

The pedicle screw accuracy using a robotic system and measured by a novel 3-dimensional method

Innovation in Neurosurgery: Lessons Learned, Obstacles, and Potential Funding Sources

Robotics planning in minimally invasive surgery for adult degenerative scoliosis: illustrative case

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