Abstract
Robotic spine surgery systems, used for placing pedicle screws, have been in clinical use since 2004; however, these systems act only as a positioner for guide tubes, which the surgeon uses to manually advance tools to prepare the site and place hardware (e.g., pedicle screws). This article presents the development, operation, and evaluation of a new, commercial-robot-based, image-guided surgery system that automates the process of bone preparation and polyaxial screw placement. The system is based on the KUKA LBR iiwa 7-axis collaborative robot. Fiducial marker and screw locations are defined on a pre-operative CT image using the 3D Slicer open source image visualization platform. The system uses the robot’s internal localization system for registration, by touching fiducial markers in a hand-guiding mode. A rotary-motor end effector with exchangeable tools is used for both hole-drilling and screw placement. A novel single-motor based mechanism was developed for placing polyaxial pedicle screws. An accuracy test was performed by placing polyaxial screws in synthetic vertebrae which mimic the mechanical properties of human bone. In placing 10 screws, the entry point accuracy was 0.49 ± 0.17 mm and the destination point accuracy was 1.49 ± 0.46 mm. The results compare favorably to evaluations of commercial robotic spine surgery systems.
Highlights
I MAGE-GUIDED, robotic spine surgery is an expanding field, with an annual composite growth rate over the five years estimated at between 9% and 22% [1], [2], [3]
To allow the fusion to occur between immobile bones, screws often are placed on both sides of each vertebra, in the pedicles
In spite of the extraordinary technologies integrated into commercial robotic spine surgery systems, the final steps of drilling and screw placement are left to the surgeon
Summary
I MAGE-GUIDED, robotic spine surgery is an expanding field, with an annual composite growth rate over the five years estimated at between 9% and 22% [1], [2], [3]. The most recent system, ExcelsiusGPS (Globus Medical, Inc., Audubon, PA) is based on a cart-mounted 6 DOF robotic arm with an integrated optical navigation system It can use preoperative CT, intraoperative CT or fluoroscopy for planning and end-effector positioning. In spite of the extraordinary technologies integrated into commercial robotic spine surgery systems, the final steps of drilling and screw placement are left to the surgeon. This is in contrast to other industries, such as robotic welding, where the robot performs the complete task automatically. We describe the design and operation of this new system and the first ex-vivo accuracy study
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