Early experience of placing image-guided minimally invasive pedicle screws without K-wires or bone-anchored trackers (original) (raw)
Related papers
Spine, 2009
Study Design. A prospective analysis. Objective. The idea of this study was to evaluate a new miniature robotic system providing passive guidance for pedicle screw placement at the lumbar spine. Special focus was laid on the postoperative accuracy of screw placement. Summary and Background Data. Recent technical developments lead to a minimization of pedicle screw fixation techniques. However, the use of navigational techniques is still under controversy. Methods. Patients selected for a minimal invasive posterior lumbar interbody fusion received a spiral computer tomographic scan before surgery. The miniature hexapod robot was mounted to the spinous process and the system moves to the exact entry point according to the trajectory of the surgeon's preoperative plan. After minimal invasive screw placement all patients received routinely a postoperative spiral computer tomographic scan. Screws placed exactly within the pedicle were evaluated as group A, screws deviating Ͻ2 mm were evaluated as group B, Ն2 mm to Ͻ4 mm (group C); Ն4 mm to Ͻ6 mm (group D); and more than 6 mm (group E). Results. Thirty-one patients received a PLIF with percutaneous posterior pedicle screw insertion using the bone mounted miniature robotic device. A total of 133 pedicle screws were placed. The majority of the screws were placed in L5 (58 screws; 43.6%). In axial plane, 91.7% of the screws were evaluated as group A and 6.8% were evaluated as group B. In longitudinal plane, 81.2% of the screws were evaluated as group A and 9.8% were evaluated as group B. In 1 screw (L5 right) the postoperative evaluation was done as group C (axial plane) and D (longitudinal plane). In 29/31 cases the integration of the miniature robotic system was successful. Conclusion. In our study the first clinical assessment of a new bone mounted robot system guiding percutaneous pedicle screw placement was done. A deviation Ͻ2 mm to the surgeon Јs plan in 91.0% to 98.5% verifies the system's accuracy.
Journal of Orthopaedics and Traumatology, 2023
Background Minimally invasive spine surgery is a field of active and intense research. Image-guided percutaneous pedicle screw (PPS) placement is a valid alternative to the standard free-hand technique, thanks to technological advancements that provide potential improvement in accuracy and safety. Herein, we describe the clinical results of a surgical technique exploiting integration of neuronavigation and intraoperative neurophysiological monitoring (IONM) for minimally invasive PPS. Materials and Methods An intraoperative-computed tomography (CT)-based neuronavigation system was combined with IONM in a three-step technique for PPS. Clinical and radiological data were collected to evaluate the safety and efficacy of the procedure. The accuracy of PPS placement was classified according to the Gertzbein-Robbins scale. Results A total of 230 screws were placed in 49 patients. Only two screws were misplaced (0.8%); nevertheless, no clinical sign of radiculopathy was experienced by these patients. The majority of the screws (221, 96.1%) were classified as grade A according to Gertzbein-Robbins scale, seven screws were classified as grade B, one screw was classified as grade D, and one last screw was classified as grade E. Conclusions The proposed three-step, navigated, percutaneous procedure offers a safe and accurate alternative to traditional techniques for lumbar and sacral pedicle screw placement.
European Spine Journal, 2010
A number of studies have shown increased accuracy of pedicle screw placement in spine with the help of computer-assisted navigation. The literature is lacking in regard to functional benefit derived from this technique. The aim of this systematic review was to look at the functional outcomes following computer-assisted pedicle screw placement in spine. A ‘Dialog Datastar’ search was used using optimized search strategy covering the period from 1950 to July 2009; 23 papers were finally included which met our inclusion criteria. We report on a total of 1,288 patients with 5,992 pedicle screws. The comparison of neurological complications in two groups demonstrated an odds ratio of 0.25 (95% CI 0.06, 1.14) in favour of using navigation for pedicle screw insertion (p = 0.07). Comparative trials demonstrated a significant advantage in terms of accuracy of navigation over conventional pedicle screw insertion with a relative risk of 1.12 (95% CI 1.09, 1.15) (p < 0.00001). Navigation does not show statistically significant benefit in reducing neurological complications and there was insufficient data in the literature to infer a conclusion in terms of fusion rate, pain relief and health outcome scores.
2019
Minimally invasive lateral interbody fusion has distinct advantages over traditional posterior approaches. When posterior stabilization is needed, percutaneous placement of pedicle screws from the lateral decubitus position may potentially increase safety and improve operative efficiency by precluding the need for repositioning. However, safe placement of pedicle screws in the lateral position remains technically challenging. This study describes the pedicle screw placement of single-position lateral lumbar interbody fusion (SP-LLIF) cases in which navigated robotic assistance was used. A single-surgeon, single-site, retrospective Institutional Review Board-exempt review of the first 55 SP-LLIF navigated robot-assisted spine surgery cases performed by the lead author was conducted. 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. In the first 55 S...
Journal of Robotic Surgery, 2019
In the emerging field of robot-assisted spine surgery, the radiographic evaluation of pedicle screw accuracy in clinical application is an area of high interest. This study describes the pedicle screw accuracy of the first 56 consecutive cases in which navigated robotic assistance was used in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 56 navigated robot-assisted spine surgery cases was performed. Pedicle screw malposition, reposition, and return to operating room (OR) rates were collected. A CT-based Gertzbein and Robbins system (GRS) was used to classify pedicle screw accuracy. In the first 56 robotic cases, 356 total pedicle screws were placed. Eight screws were placed without the robot due to surgeon discretion. Of the 348 pedicle screws inserted by navigated robotic guidance, only 2.6% (9/348) were repositioned, resulting in a 97.4% (339/348) successful screw placement rate. The average age was 64, and 48% were fem...
Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws
Neurosurgical focus, 2017
Objective Recent studies have investigated the role of spinal image guidance for pedicle screw placement. Many authors have observed an elevated placement accuracy and overall improvement of outcome measures. This study assessed a bi-institutional experience following introduction of the Renaissance miniature robot for spinal image guidance in Europe. Methods The medical records and radiographs of all patients who underwent robot-guided implantation of spinal instrumentation using the novel system (between October 2011 and March 2015 in Mainz and February 2014 and February 2016 in Regensburg) were reviewed to determine the efficacy and safety of the newly introduced robotic system. Screw position accuracy, complications, exposure durations to intraoperative radiation, and reoperation rate were assessed. Results Of the 413 surgeries that used robotic guidance, 406 were via a minimally invasive approach. In 7 cases the surgeon switched to conventional screw placement, using a midline ...
Journal of Robotic Surgery
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.
Orthopedics, 2015
Complications arising from a malpositioned screw can be both devastating and costly. The incidence of neurologic injury secondary to a malpositioned screw is reported to be as high as 7% to 12%. The advancement of image-guided technology has allowed surgeons to place screws more accurately and confirm correct placement prior to leaving the operating room. Only a small number of studies have examined image-guided pedicle screw accuracy in terms of intraoperative revision and reoperation rates. The purpose of this study was to determine the intraoperative revision and return to surgery rates for navigated lumbar pedicle screws and to compare navigated open and percutaneous techniques. The authors reviewed 199 cases of 3-dimensional image-guided lumbar pedicle screw instrumentation from November 2006 to December 2011. Screw or K-wire removal, repositioning, or eventual abandonment of insertion were noted. Chi-square test was used to determine statistical significance in rates between t...
Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results
Journal of Neurosurgery: Spine, 2002
Object. Standard techniques for pedicle screw fixation of the lumbar spine involve open exposures and extensive muscle dissection. The purpose of this study was to report the initial clinical experience with a novel device for percutaneous posterior fixation of the lumbar spine. Methods. An existing multiaxial lumbar pedicle screw system was modified to allow screws to be placed percutaneously by using an extension sleeve that permits remote manipulation of the polyaxial screw heads and remote engagement of the screw-locking mechanism. A unique rod-insertion device was developed that linked to the screw extension sleeves, allowing for a precut and -contoured rod to be placed through a small stab wound. Because the insertion device relies on the geometrical constraint of the rod pathway through the screw heads, minimal manipulation is required to place the rods in a standard submuscular position, there is essentially no muscle dissection, and the need for direct visual feedback is av...
The International Journal of Medical Robotics and Computer Assisted Surgery
Background: In the emerging field of robot-assisted spine surgery, radiographic evaluation of pedicle screw accuracy in the surgical setting is of high interest. Advances in medical imaging have improved the accuracy of pedicle screw placement, from fluoroscopy-guided to computer-aided navigation. Methods: A retrospective, institutional review board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed. Radiographic evaluation of preoperative and postoperative computerized tomography (CT) scans were collected. Results: In the first 106 cases, 630 lumbosacral pedicle screws were placed. Thirty screws were placed in five patients without the robot because of surgeon discretion. Of the 600 pedicle screws inserted by navigated robotic guidance, only 1.5% (9/600) were repositioned intraoperatively. Conclusion: This study demonstrated a high level of accuracy (98.2%) in terms of grade A or B pedicle screw breach scores in the clinical use of navigated, robotassisted surgery in its first 101 cases.