Use of a high-speed drill in robotics coupled with navigation for pediatric spine surgery.

Abstract

With the increasing number of surgeries for pediatric spinal deformities, the aim has been to reduce the associated complications, such as those caused by screw malposition. This case series is an intra-operative experience with a newnavigated high-speed revolution drill (Mazor Midas, Medtronic, Minneapolis, MN) for pediatric spinal deformity to assess accuracy and workflow. 88 patients, ranging from 2 to 29years of age, were included who underwent posterior spinal fusion with the navigated high-speed drill. Diagnoses, Cobb angles, imaging, surgical time, complications, and total number of screws placed are described. Screw positioning was evaluated using fluoroscopy, plain radiography, and CT. Mean age was 15.4years old. Diagnoses included 47 adolescent idiopathic scoliosis, 15 neuromuscular scoliosis, 8 spondylolisthesis, 4 congenital scoliosis, and 14 other. The mean Cobb angulation for scoliosis patients was 64° and the mean number of levels fusedwas 10. 81 patients had registration via intraoperative 3-D imaging and 7 had pre-operative CT scan to fluoroscopy registration. There were a total of 1559 screwswith 925 placed robotically. 927 drill paths weredrilled with the Mazor Midas. 926 out of 927 drill paths were accurate. The mean surgical time was 304min with the mean robotic time being 46min. This is the first intra-operative report to our knowledge documenting the experience with the Mazor Midas drill in pediatric spinal deformity showing decreased skiving potential, decreased torque when drilling, and lastly increased accuracy. Level of evidence: level III.