Does the accuracy of pedicle screw placement differ between the attending surgeon and resident in navigated robotic-assisted minimally invasive spine surgery?

Arnold B Vardiman,Jessica R Riggleman,Charles G Ledonio,Grant A Booher,Neil R Crawford,Samantha L Greeley,David J Wallace

doi:10.1007/s11701-019-01019-9

Abstract

Robotic assistance with integrated navigation is an area of high interest for improving the accuracy of minimally invasive pedicle screw placement. This study analyzes the accuracy of pedicle screw placement between an attending spine surgeon and a resident by comparing the left and right sides of the first 101 consecutive cases using navigated robotic assistance in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed. One attending spine surgeon and one resident performed pedicle screw placement consistently on either the left or right side (researchers were blinded). A CT-based Gertzbein and Robbins system (GRS) was used to classify pedicle screw accuracy, with grade A or B considered accurate. There were 630 consecutive lumbosacral pedicle screws placed. Thirty screws (5 patients) were placed without the robot due to surgeon discretion. Of the 600 pedicle screws inserted by navigated robotic guidance (101 patients), only 1.5% (9/600) were repositioned intraoperatively. Based on the GRS CT-based grading of pedicle breach, 98.67% (296/300) of left-side screws were graded A or B, 1.3% (4/300) were graded C, and 0% (0/300) were graded D. For the right-side screws, 97.67% (293/300) were graded A or B, 1.67% (5/300) were graded C, and 0.66% (2/300) were graded D. This study demonstrated a high level of accuracy (based on GRS) with no significant differences between the left- and right-side pedicle screw placements (98.67% vs. 97.67%, respectively) in the clinical use of navigated, robot-assisted surgery.

Highlights

The traditional teaching method of orthopedic residents for spine surgery is through a preceptorship or apprenticeship approach to orthopedic surgical training with 1:1 training with an attending surgeon, rotating through orthopedic subspecialties
It was revealed that pedicle screw placement on the left was performed by the resident and by the attending on right side of the spine
Of the 600 pedicle screws inserted by navigated robotic guidance (101 patients), 300 screws were placed on the left and 300 screws were placed on the right

Summary

Introduction

The traditional teaching method of orthopedic residents for spine surgery is through a preceptorship or apprenticeship approach to orthopedic surgical training with 1:1 training with an attending surgeon, rotating through orthopedic subspecialties. Free-hand pedicle screw placement includes an increased risk of screw misplacement and a high risk of radiation to the surgeons, operating room staff, and the patients [2] This has been the motivation for the advancement of navigated robot-assisted spine surgery. This study analyzes the accuracy of pedicle screw placement between an attending spine surgeon and a resident by comparing the left and right sides of the first 101 consecutive cases using navigated robotic assistance in a private practice clinical setting. One attending spine surgeon and one resident performed pedicle screw placement consistently on either the left or right side This sequence was repeated until all pedicle screws were placed. Surgical incisions were cleaned and closed in the standard fashion This is a retrospective, Institutional Review Board exempt study of the first 101 navigated robot-assisted spine surgery cases at a single site. Reposition, and return to operating room (OR) rates were collected

Results

Discussion

Study limitations

Conclusion

Compliance with ethical standards