Autonomous Spinal Robotic System for Transforaminal Lumbar Epidural Injections: A Proof of Concept of Study.

Abstract

Phantom study. The aim of our study is to demonstrate in a proof-of-concept model whether the use of a marker less autonomous robotic controlled injection delivery system will increase accuracy in the lumbar spine. Ideal transforaminal epidural injection trajectories (bilateral L2/3, L3/4, L4/5, L5/S1 and S1) were planned out on a virtual pre-operative planning software by 1 experienced provider. Twenty transforaminal epidural injections were administered in a lumbar spine phantom model, 10 using a freehand procedure, and 10 using a marker less autonomous spinal robotic system. Procedural accuracy, defined as the difference between pre-operative planning and actual post-operative needle tip distance (mm) and angular orientation (degrees), were assessed between the freehand and robotic procedures. Procedural accuracy for robotically placed transforaminal epidural injections was significantly higher with the difference in pre- and post-operative needle tip distance being 20.1 (±5.0) mm in the freehand procedure and 11.4 (±3.9) mm in the robotically placed procedure (P < .001). Needle tip precision for the freehand technique was 15.6mm (26.3 - 10.7) compared to 10.1mm (16.3 - 6.1) for the robotic technique. Differences in needle angular orientation deviation were 5.6 (±3.3) degrees in the robotically placed procedure and 12.0 (±4.8) degrees in the freehand procedure (P = .003). The robotic system allowed for comparable placement of transforaminal epidural injections as a freehand technique by an experienced provider, with additional benefits of improved accuracy and precision.