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      Robotic-assisted navigated minimally invasive pedicle screw placement in the first 100 cases at a single institution

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          Abstract

          Proper pedicle screw placement is an integral part of spine fusion requiring expertly trained spine surgeons. Advances in medical imaging guidance have improved accuracy. There is high interest in the emerging field of robot-assisted spine surgery; however, safety and accuracy studies are needed. This study describes the pedicle screw placement of the first 100 cases in which navigated robotic assistance was used in a private practice clinical setting. A single-surgeon, single-site retrospective Institutional Review Board-exempt review of the first 100 navigated robot-assisted spine surgery cases was performed. An orthopaedic surgeon evaluated screw placement using plain film radiographs. In addition, pedicle screw malposition, reposition, and return to operating room (OR) rates were collected. Results demonstrated a high level (99%) of successful surgeon assessed pedicle screw placement in minimally invasive navigated robot-assisted spine surgery, with no malpositions requiring return to the OR.

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          Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques.

          Ioannis D Gelalis, Nikolaos K Paschos, Emilios E Pakos … (2012)
          With the advances and improvement of computer-assisted surgery devices, computer-guided pedicle screws insertion has been applied to the lumbar, thoracic and cervical spine. The purpose of the present study was to perform a systematic review of all available prospective evidence regarding pedicle screw insertion techniques in the thoracic and lumbar human spine. We considered all prospective in vivo clinical studies in the English literature that assessed the results of different pedicle screw placement techniques (free-hand technique, fluoroscopy guided, computed tomography (CT)-based navigation, fluoro-based navigation). MEDLINE, OVID, and Springer databases were used for the literature search covering the period from January 1950 until May 2010. 26 prospective clinical studies were eventually included in the analysis. These studies included in total 1,105 patients in which 6,617 screws were inserted. In the studies using free-hand technique, the percentage of the screws fully contained in the pedicle ranged from 69 to 94%, with the aid of fluoroscopy from 28 to 85%, using CT navigation from 89 to 100% and using fluoroscopy-based navigation from 81 to 92%. The screws positioned with free-hand technique tended to perforate the cortex medially, whereas the screws placed with CT navigation guidance seemed to perforate more often laterally. In conclusion, navigation does indeed exhibit higher accuracy and increased safety in pedicle screw placement than free-hand technique and use of fluoroscopy.
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            Complications of pedicle screw fixation in scoliosis surgery: a systematic review.

            Vincent Arlet, Amit Singla, F. Shen … (2010)
            Systematic review. To review the published literature on the use of pedicle screws in pediatric spinal deformity to quantify the risks and complications associated with pedicle screw instrumentation, particularly in the thoracic spine. The use of pedicle screws in adolescent scoliosis surgery is common. Although many reports have been published regarding the use of pedicle screws in pediatric patients, there has been no systematic review on the risks of complications. PubMed, Ovid Medline, and Cochrane databases were searched for studies reporting the use of thoracic pedicle screws in pediatric deformity. We excluded articles dealing with neuromuscular scoliosis or bone dysplasia to focus mostly on adolescent thoracic idiopathic scoliosis and the likes. We then searched for cases reports dealing with thoracic pedicle screws complications. This systematic review retrieved 21 studies with a total of 4570 pedicle screws in 1666 patients. The mean age of the patients was 17.6 years; 812 patients were women and 252 were men, and 5 studies did not identify sex. Overall, 518 (4.2%) screws were reported as malpositioned. However, in studies in which postoperative computed tomography scans were done systematically, the rate of screw malpositioning was as high as 15.7%. The reported percentage of patients with screw malpositioned is around 11%. Eleven patients underwent revision surgery for instrumentation malposition. Other complications reported include loss of curve correction, intraoperative pedicle fracture or loosening, dural laceration, deep infection, pseudarthrosis, and transient neurologic injury. There were no major vascular complications reported in these 21 studies. We could identify 9 case report articles dealing with complications of pedicle screws. Such complications were mostly either vascular (10 cases) or neurologic (4 cases), without any irreversible complications. Malposition is the most commonly reported complication of thoracic pedicle screw placement, at a rate of 15.7% per screw inserted with postoperative computed tomography scans. The use of pedicle screws in the thoracic spine for the treatment of pediatric deformity has been reported to be safe despite the high rate of patients with malpositioned screws (11%). Major complications, such as neurologic or vascular injury, were almost never reported in this literature review of case series. Cases reports on the other hand have started to identify such complications.
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              The accuracy of pedicle screw placement using intraoperative image guidance systems.

              Alexander Mason, Renee Paulsen, Jason Babuska … (2014)
              Several retrospective studies have demonstrated higher accuracy rates and increased safety for navigated pedicle screw placement than for free-hand techniques; however, the accuracy differences between navigation systems has not been extensively studied. In some instances, 3D fluoroscopic navigation methods have been reported to not be more accurate than 2D navigation methods for pedicle screw placement. The authors of this study endeavored to identify if 3D fluoroscopic navigation methods resulted in a higher placement accuracy of pedicle screws.
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                Author and article information

                Contributors
                Leigh A. Ahrendtsen: lahrendtsen@globusmedical.com
                Journal
                Journal ID (nlm-ta): J Robot Surg
                Journal ID (iso-abbrev): J Robot Surg
                Title: Journal of Robotic Surgery
                Publisher: Springer London (London )
                ISSN (Print): 1863-2483
                ISSN (Electronic): 1863-2491
                Publication date (Electronic): 23 April 2019
                Publication date PMC-release: 23 April 2019
                Publication date (Print): 2020
                Volume: 14
                Issue: 1
                Pages: 199-203
                Affiliations
                [1 ]Salt Lake Orthopaedic Clinic, Suite 500, 1160 East 3900 South, Salt Lake City, UT 84124 USA
                [2 ]GRID grid.459811.0, ISNI 0000 0004 0376 7450, Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., ; 2560 General Armistead Avenue, Audubon, PA 19403 USA
                Article
                Publisher ID: 959
                DOI: 10.1007/s11701-019-00959-6
                PMC ID: 7000538
                PubMed ID: 31016575
                SO-VID: d8ab8def-28b7-47fd-af11-a0dbc287b776
                Copyright © © The Author(s) 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 28 February 2019
                Date accepted : 9 April 2019
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag London Ltd., part of Springer Nature 2020

                ScienceOpen disciplines: Surgery
                Keywords: robotic-navigated,pedicle screw placement,minimally invasive,spine surgery
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: robotic-navigated, pedicle screw placement, minimally invasive, spine surgery

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