Robotics Reduces Radiation Exposure in Minimally Invasive Lumbar Fusion Compared With Navigation

Shahi, Pratyush; Vaishnav, Avani S.; Araghi, Kasra; Shinn, Daniel; Song, Junho; Dalal, Sidhant; Melissaridou, Dimitra; Mai, Eric; Dupont, Marcel; Sheha, Evan; Dowdell, James; Iyer, Sravisht; Qureshi, Sheeraz A.

doi:10.1097/brs.0000000000004381

Cited by 30 publications

(28 citation statements)

References 46 publications

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“…Revision surgeries were excluded. Surgeries included were performed as previously described in the literature [9][10][11][12][13][14][15][16][17] by fellowship-trained spine surgeons with practices dedicated to minimally invasive spine surgery.…”

Section: Study Design and Patient Cohortmentioning

confidence: 99%

ODI <25 Denotes Patient Acceptable Symptom State After Minimally Invasive Lumbar Spine Surgery

Shahi

Shinn

Singh

et al. 2022

Spine

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Study Design. Retrospective review of prospectively collected data. Objective. To determine the Oswestry Disability Index (ODI) cutoff for achieving Patient Acceptable Symptom State (PASS) at one year following minimally invasive lumbar spine surgery. Summary of Background Data. An absolute score denoting PASS, rather than a change score denoting minimal clinically important difference (MCID), might be a better metric to assess clinical outcomes. Materials and Methods. Patients who underwent primary minimally invasive transforaminal lumbar interbody fusion or decompression were included. The outcome measure was ODI. The anchor question was the Global Rating Change. "Compared with preoperative, you feel (1) much better, (2) slightly better, (3) same, (4) slightly worse, or (5) much worse." For analysis, it was collapsed to a dichotomous outcome variable (acceptable = response of 1 or 2, unacceptable = response of 3, 4, or 5). Proportion of patients achieving PASS and the ODI cutoff using receiver operating characteristic curve analyses were assessed for the overall cohort as well as subgroups based on age, sex, type of surgery, and preoperative ODI. Differences between the PASS and MCID metrics were analyzed. Results. A total of 137 patients were included. In all, 87% of patients achieved PASS. Patients less than or equal to 65 years and those undergoing fusion were more likely to achieve PASS. The receiver operating characteristic curve analysis revealed an ODI cutoff of 25.2 to achieve PASS (area under the curve. 0.872, sensitivity: 82%, specificity: 83%). The subgroup analyses based on age, sex, and preoperative ODI revealed area under the curve > 0.8 and ODI threshold values consistent between 25.2 and 25.5 (except 28.4 in patients with preoperative ODI > 40). PASS was found to have significantly higher sensitivity compared with MCID (82% vs. 69%, P = 0.01). Conclusions. Patients with ODI <25 are expected to achieve PASS, irrespective of age, sex, and preoperative disability. PASS was found to have significantly higher sensitivity than MCID.

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Section: Study Design and Patient Cohortmentioning

confidence: 99%

ODI <25 Denotes Patient Acceptable Symptom State After Minimally Invasive Lumbar Spine Surgery

Shahi

Shinn

Singh

et al. 2022

Spine

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“…The literature on radiation exposure comparing both techniques is heterogenous 8,19,20 . Data with comparable, reduced or increased radiation exposure using the robot‐assisted techniques are found.…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted versus navigated transpedicular spine fusion: A comparative study

Romagna

Sperker

Lumenta

et al. 2023

Robotics Computer Surgery

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Background:The aim of this study was to compare the intraoperative and postoperative outcomes between a robot-assisted versus a navigated transpedicular fusion technique.Methods: This retrospective analysis included patients who underwent transpedicular posterior fusion of the spine due to trauma, pyogenic spondylodiscitis and osteoporosis. Surgery was done either with a robot-assisted or a percutaneous navigated transpedicular fusion technique. The outcome analysis included the duration of surgery, the radiation exposure, the postoperative screw position and complications.Results: A total of 60 patients were operated and 491 screws were analysed. No statistical difference was seen in the applied cumulative effective radiation dose per patient. The radiological assessment revealed a more accurate screw placement with robot assistance. A learning curve could be observed in robot-assisted fusion. Conclusion:Robot-assisted and navigated transpedicular fusion techniques are both effective and safe. Robot-assisted transpedicular spine fusion goes along with higher placement accuracy but its implementation needs an adequate learning curve.

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“…The surgeon and surgical staff are not exposed to the initial (preoperative or intraoperative) CT scan. Shahi et al demonstrated significant reduction in radiation exposure both to the surgeon and the patient with robotics compared to navigation, with no significant difference in the operative time ( 34 ).…”

Section: Commentsmentioning

confidence: 99%

Step-by-step guide to robotic-guided minimally invasive transforaminal lumbar interbody fusion (MI-TLIF)

Sarmiento¹,

Shahi²,

Melissaridou³

et al. 2023

Ann Transl Med

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Robotics in spinal surgery offers a promising potential to refine and improve the minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) technique. Suitable surgeons for this technique include those who are already familiar with robotic-guided lumbar pedicle screw placement and want to advance their skillset by incorporating posterior-based interbody fusion. We provide a step-by-step guide for robotic-guided MI-TLIF. The procedure is divided into 7 practical and detailed techniques. The steps in sequential order include: (I) planning trajectories for pedicle screws and the tubular retractor; (II) robotic-guided pedicle screw placement; (III) placement of tubular retractor; (IV) unilateral facetectomy using the surgical microscope; (V) discectomy & disc preparation; (VI) interbody implant insertion; and(VII) percutaneous rod placement. We standardize surgeon training in robotic MI-TLIF by teaching our spine surgery fellows these 7 key technical steps highlighted in this guide. Current-generation robotics offers integrated navigation capability, K-wireless placement of pedicle screws through a rigid robotic arm, compatibility with tubular retractor systems to perform facetectomy, and allows for placement of interbody devices. We have found robotic-guided MI-TLIF to be a safe procedure that allows for accurate and reliable pedicle screw placement, less collateral damage to the soft tissues of the low back, and decreased radiation exposure.

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Robotics Reduces Radiation Exposure in Minimally Invasive Lumbar Fusion Compared With Navigation

Cited by 30 publications

References 46 publications

ODI <25 Denotes Patient Acceptable Symptom State After Minimally Invasive Lumbar Spine Surgery

ODI <25 Denotes Patient Acceptable Symptom State After Minimally Invasive Lumbar Spine Surgery

Robot‐assisted versus navigated transpedicular spine fusion: A comparative study

Step-by-step guide to robotic-guided minimally invasive transforaminal lumbar interbody fusion (MI-TLIF)

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