Abstract
Background: Robot-guided spine surgery is based on a preoperatively planned trajectory that is reproduced in the operating room by the robotic device. This study presents our initial experience with thoracolumbar pedicle screw placement using Brainlab’s Cirq® surgeon-controlled robotic arm (BrainLab, Munich, Germany). Methods: All patients who underwent robotic-assisted implantation of pedicle screws in the thoracolumbar spine were included in the study. Our workflow, consisting of preoperative imagining, screw planning, intraoperative imaging with automatic registration, fusion of the preoperative and intraoperative imaging with a review of the preplanned screw trajectories, robotic-assisted insertion of K-wires, followed by a fluoroscopy-assisted insertion of pedicle screws and control iCT scan, is described. Results: A total of 12 patients (5 male and 7 females, mean age 67.4 years) underwent 13 surgeries using the Cirq® Robotic Alignment Module for thoracolumbar pedicle screw implantation. Spondylodiscitis, metastases, osteoporotic fracture, and spinal canal stenosis were detected. A total of 70 screws were implanted. The mean time per screw was 08:27 ± 06:54 min. The mean time per screw for the first 7 surgeries (first 36 screws) was 16:03 ± 09:32 min and for the latter 6 surgeries (34 screws) the mean time per screw was 04:35 ± 02:11 min (p < 0.05). Mean entry point deviation was 1.9 ± 1.23 mm, mean deviation from the tip of the screw was 2.61 ± 1.6 mm and mean angular deviation was 3.5° ± 2°. For screw-placement accuracy we used the CT-based Gertzbein and Robbins System (GRS). Of the total screws, 65 screws were GRS A screws (92.85%), one screw was a GRS B screw, and two further screws were grade C. Two screws were D screws (2.85%) and underwent intraoperative revision. There were no perioperative deficits. Conclusion: Brainlab’s Cirq® Robotic Alignment surgeon-controlled robotic arm is a safe and beneficial method for accurate thoracolumbar pedicle screw placement with high accuracy.
Highlights
There were approximately 3.6 million spine surgery cases in the United States between 2001 and 2010, with increasing prevalence each year [1]
A Robotic Alignment Module, on the other hand, requires that the surgeon places a robotic arm over the entry point of the preplanned screw trajectory; following this, the robotic arm automatically aligns to the preplanned trajectory and, in this manner, minimizes the potential error
[51] Of the 600 pedicle screws inserted by navigated robotic guidance (101 patients), only 1.5% (9/600) were repositioned intraoperatively in the study by Vardiman et al using the same robotic system (Excelsius GPS); this study demonstrated a high level of accuracy with no significant differences between the left- and right-side pedicle screw placements (98.67% vs. 97.67%, respectively) in the clinical use, whereas screws on the left were placed by resident and screws on the right by attending surgeon [52]
Summary
There were approximately 3.6 million spine surgery cases in the United States between 2001 and 2010, with increasing prevalence each year [1]. Guidance to the surgeon in robot-guided spine surgery is based on a preoperatively planned trajectory that is reproduced in the operating room by the robotic device. In one variant, this device is mounted to the patient’s spine for drilling holes in preparation for the placement of pedicle screws. Robot-guided spine surgery is based on a preoperatively planned trajectory that is reproduced in the operating room by the robotic device. Results: A total of patients (5 male and 7 females, mean age 67.4 years) underwent surgeries using the Cirq® Robotic Alignment Module for thoracolumbar pedicle screw implantation. Conclusion: Brainlab’s Cirq® Robotic Alignment surgeon-controlled robotic arm is a safe and beneficial method for accurate thoracolumbar pedicle screw placement with high accuracy
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