Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: an evaluation of the first 54 cases

Carlo Alberto Benech,Charles Ledonio,Rosa Perez,Neil Crawford,Samantha L Greeley,Franco Benech

doi:10.1007/s11701-019-01007-z

Carlo Alberto Benech, Charles Ledonio + Show 4 more

Open Access

https://doi.org/10.1007/s11701-019-01007-z

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Abstract

Computer-aided navigation and robotic guidance systems have become widespread in their utilization for spine surgery. A recent innovation combines these two advances, which theoretically provides accuracy in spinal screw placement. This study describes the cortical and pedicle screw accuracy for the first 54 cases where navigated robotic assistance was used in a surgical setting. This is a retrospective chart review of the initial 54 patients undergoing spine surgery with pedicle and cortical screws using robotic guidance with navigation. A computed tomography (CT)-based Gertzbein and Robbins System (GRS) was used to classify pedicle screw accuracy. Screw tip, tail, and angulation offsets were measured using image overlay analysis. Screw malposition, reposition, and return to operating room rates were collected. 1 of the first 54 cases was a revision surgery and was excluded from the study. Ten screws were placed without the robot due to surgeon discretion and were excluded for the data analysis of 292 screws. Only 0.68% (2/292) of the robot-assisted screws was repositioned based on surgeon discretion. Based on the GRS CT-based grading, 98.3% (287/292) were graded A or B, 1.0% (3/292) screws were graded C, and only 0.7% (2/292) screws was graded D. The average offset from preoperative plan to actual final placement was 1.9 mm from the tip, 2.3 mm from the tail, and 2.8° of angulation. In the first 53 cases, 292 screws placed with navigated robotic assistance resulted in a high level of accuracy (98.3%), adequate screw offsets from planned trajectory, and zero complications.

Highlights

In spine surgery, cortical and pedicle screws are routinely placed for posterior spinal fixation to stabilize and promote fusion
In an effort to decrease the amount of radiation exposure while promoting accurate screw placement, navigated robotassisted spine surgery was developed as a stable platform to enhance the ability of spine surgeons to perform accurate surgery
The current study showed pedicle screw placement accuracy of 98%, based on Gertzbein and Robbins System (GRS) grading, for the first 52 patients or 292 screws placed with robotic guidance and navigation

Summary

Introduction

Cortical and pedicle screws are routinely placed for posterior spinal fixation to stabilize and promote fusion. Misplaced screws are biomechanically disadvantageous and carry an increased risk for neurological deficit, vascular damage, and morbidity [1,2,3]. Advances in imaging and navigation such as fluoroscopic guidance have improved the accuracy of screw placement in the spine, yet significantly increased the amount of radiation exposure to the patient, surgeon, and operating room (OR) staff [4, 5]. In an effort to decrease the amount of radiation exposure while promoting accurate screw placement, navigated robotassisted spine surgery was developed as a stable platform to enhance the ability of spine surgeons to perform accurate surgery. The purpose of this study is to describe the cortical and pedicle screw accuracy and screw offset for the first 54 cases in which navigated robotic assistance was used

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