Abstract
In the emerging field of robot-assisted spine surgery, the radiographic evaluation of pedicle screw accuracy in clinical application is an area of high interest. This study describes the pedicle screw accuracy of the first 56 consecutive cases in which navigated robotic assistance was used in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 56 navigated robot-assisted spine surgery cases was performed. Pedicle screw malposition, reposition, and return to operating room (OR) rates were collected. A CT-based Gertzbein and Robbins system (GRS) was used to classify pedicle screw accuracy. In the first 56 robotic cases, 356 total pedicle screws were placed. Eight screws were placed without the robot due to surgeon discretion. Of the 348 pedicle screws inserted by navigated robotic guidance, only 2.6% (9/348) were repositioned, resulting in a 97.4% (339/348) successful screw placement rate. The average age was 64, and 48% were female. Average body mass index was 31 kg/m2. Based on the GRS CT-based grading, 97.7% (340/348) were graded A or B, 1.7% (6/348) screws were graded C, and only 0.6% (2/348) of screws were graded D. Two complications, explantation of interbody and vacuum-assisted wound closure, were reported as requiring a return to the OR, but these were not related to robotic guidance or pedicle screws. This study demonstrated a high level of accuracy (97.7%) in the first 56 cases using navigated, robot-assisted surgery based on the GRS. There were two non-screw-related complications requiring return to the operating room.
Highlights
Pedicle screw constructs have become the standard for stabilization and fusion in spinal surgery[1]
Of the 348 pedicle screws inserted by navigated robotic guidance, 2.6% (9/349) were repositioned resulting in a 97.4% (339/348) successful screw placement rate
Based on the Gertzbein and Robbins system (GRS) classification, 97.7% (340/348) were graded as A or B, 1.7% (6/348) screws were graded as C, and only 0.6% (2/348) screws were graded as D
Summary
Pedicle screw constructs have become the standard for stabilization and fusion in spinal surgery[1]. Pedicle screws are widely used in the pediatric and adult population and have shown favorable results, with benefits outweighing risks[3]. Since the launch of pedicle screws for spinal stabilization, numerous techniques have been used to direct and confirm screw placement[4]. Examples of these techniques include anatomic landmarks, plain film radiography, standard or image-guided fluoroscopic imaging, and computed tomography (CT) image guidance[5,6,7]. Comparisons between different approaches, along with the benefits and limitations of each method, have been published[8].
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