The current state of navigation in robotic spine surgery

Abstract

The advent and widespread adoption of pedicle screw instrumentation prompted the need for image guidance in spine surgery to improve accuracy and safety. Although the conventional method, fluoroscopy, is readily available and inexpensive, concerns regarding radiation exposure and the drive to provide better visual guidance spurred the development of computer-assisted navigation.Contemporaneously, a non-navigated robotic guidance platform was also introduced as a competing modality for pedicle screw placement. Although the robot could provide high precision trajectory guidance by restricting four of the six degrees of freedom (DOF), the lack of real-time depth control and high capital acquisition cost diminished its popularity, while computer-assisted navigation platforms became increasingly sophisticated and accepted. The recent integration of real-time 3D navigation with robotic platforms has resulted in a resurgence of interest in robotics in spine surgery with the recent introduction of numerous navigated robotic platforms. The currently available navigated robotic spine surgery platforms include the

Comparison of accuracy and safety between robot-assisted and conventional fluoroscope assisted placement of pedicle screws in thoracolumbar spine

“…The advantage of Chinese TIROBOT is that real-time navigation can be obtained according to the three-dimensional images during the operation. [ 29 ] However, some scholars have pointed out that in the process of 3D image reconstruction and registration, distortion will occur due to electromagnetic field deflection, which will affect the system error of the robot. [ 30 ] The accuracy of pedicle screw placement assisted by robot is more than 90%.…”

Comparative Analysis of Optoelectronic Accuracy in the Laboratory Setting Versus Clinical Operative Environment: A Systematic Review

“…An extensive number of peer reviewed journal publications have documented the use, efficacy safety and technical accuracy achieved with robotic-assisted spinal surgery. 23 , 28 , 30 , 37 , 39 - 41 , 44 - 46 , 93 - 123 The focus in reviewing these publications was to highlight the technical accuracy observations and determine a basis for discrepancy between planned versus actual final implant position based on postoperative CT images. In case studies where quantitative measurements were not reported, the Gertzbein and Robbins 124 score (GRS) was adopted to calculate pedicle screw implant position.…”

Robotic Spine Surgery: Past, Present, and Future

“…The upgrade included a fully integrated navigation interface and Zimmer Biomet instrumentation package as well as adaptation across cranial, spinal, and orthopedic knee arthroplasty procedures. 6…”

“…6,17,18 The TiRobot (Figure 7) 6,19,20 and the Asenus systems have not yet received FDA clearance for use in spine surgical procedures in the United States. 6…”

“…In 2016, Zimmer Biomet received FDA clearance for their ROSA Spine System 6,7 (Figure 8). This free-standing robotic spine surgical navigation system utilizes a robotic arm and navigation camera, each mounted to its own floor-fixable mobile base, to guide pedicle entry points, and trajectories in the thoracic and lumbar spines.…”