Abstract
The combination of navigation and robotics in spine surgery has the potential to accurately identify and maintain bone entry position and planned trajectory. The goal of this study was to examine the feasibility, accuracy and efficacy of a new robot-guided system for semi-automated, minimally invasive, pedicle screw placement. A custom robotic arm was integrated into a hybrid operating room (OR) equipped with an augmented reality surgical navigation system (ARSN). The robot was mounted on the OR-table and used to assist in placing Jamshidi needles in 113 pedicles in four cadavers. The ARSN system was used for planning screw paths and directing the robot. The robot arm autonomously aligned with the planned screw trajectory, and the surgeon inserted the Jamshidi needle into the pedicle. Accuracy measurements were performed on verification cone beam computed tomographies with the planned paths superimposed. To provide a clinical grading according to the Gertzbein scale, pedicle screw diameters were simulated on the placed Jamshidi needles. A technical accuracy at bone entry point of 0.48 ± 0.44 mm and 0.68 ± 0.58 mm was achieved in the axial and sagittal views, respectively. The corresponding angular errors were 0.94 ± 0.83° and 0.87 ± 0.82°. The accuracy was statistically superior (p < 0.001) to ARSN without robotic assistance. Simulated pedicle screw grading resulted in a clinical accuracy of 100%. This study demonstrates that the use of a semi-automated surgical robot for pedicle screw placement provides an accuracy well above what is clinically acceptable.
Highlights
The combination of navigation and robotics in spine surgery has the potential to accurately identify and maintain bone entry position and planned trajectory
A clinical accuracy of 89% without, and 100% with instrument tracking, in minimally invasive spine (MIS) surgery has previously been demonstrated with the augmented reality surgical navigation system (ARSN)[17,18]
We examine the integration of a surgical robot with the ARSN system
Summary
The combination of navigation and robotics in spine surgery has the potential to accurately identify and maintain bone entry position and planned trajectory. Intraoperative fluoroscopy or CT is used for 3D planning in the ROSA system, which utilizes a navigation camera and reference markers attached to the patient and two attached to the robot, which allows for real-time instrument tracking Both systems employ a robotic arm for instrument guidance[10]. A clinical accuracy of 89% without, and 100% with instrument tracking, in MIS surgery has previously been demonstrated with the augmented reality surgical navigation system (ARSN)[17,18]. We investigate whether the addition of a robotic arm to identify and maintain entry position and planned trajectory, increases accuracy and if it adds surgical time compared to non-robot-assisted pedicle screw placement using the same ARSN system and reported rates for robot-assisted surgery in the literature. Using the ARSN, the radiation exposure to the staff is negligible and no lead aprons are required[21,22]
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