Robotic-assisted navigated minimally invasive pedicle screw placement in the first 100 cases at a single institution

Kade T Huntsman,Jessica R Riggleman,Charles G Ledonio,Leigh A Ahrendtsen

doi:10.1007/s11701-019-00959-6

Abstract

Proper pedicle screw placement is an integral part of spine fusion requiring expertly trained spine surgeons. Advances in medical imaging guidance have improved accuracy. There is high interest in the emerging field of robot-assisted spine surgery; however, safety and accuracy studies are needed. This study describes the pedicle screw placement of the first 100 cases in which navigated robotic assistance was used in a private practice clinical setting. A single-surgeon, single-site retrospective Institutional Review Board-exempt review of the first 100 navigated robot-assisted spine surgery cases was performed. An orthopaedic surgeon evaluated screw placement using plain film radiographs. In addition, pedicle screw malposition, reposition, and return to operating room (OR) rates were collected. Results demonstrated a high level (99%) of successful surgeon assessed pedicle screw placement in minimally invasive navigated robot-assisted spine surgery, with no malpositions requiring return to the OR.

Highlights

Pedicle screw constructs are widely used for posterior fixation in spinal surgery because of their biomechanical superiority and significant correction
Safe pedicle screw placement is paramount to achieving successful spine surgery [1]
Advances in medical imaging have improved the accuracy of pedicle screw placement from fluoroscopic-guided to computer-aided navigation [8]

Summary

Introduction

Pedicle screw constructs are widely used for posterior fixation in spinal surgery because of their biomechanical superiority and significant correction. Safe pedicle screw placement is paramount to achieving successful spine surgery [1]. Pedicle screws are widely used in both young and adult patients, with numerous articles documenting a favorable risk-to-benefit ratio for spinal treatment [3]. Various techniques have been used to guide and confirm pedicle screw placement [4]. Advances in medical imaging have improved the accuracy of pedicle screw placement from fluoroscopic-guided to computer-aided navigation [8]. The most recent advancement is the use of a navigated robotic-assisted spine surgery system designed to increase the accuracy of pedicle screw placement compared to freehand placement. Clinical outcome studies are required to determine pedicle screw placement accuracy when minimally invasive navigated robotic-assisted spine surgery was performed on the first 100 patients at a single institution

Methods

Results

Conclusion