Pedicle screw accuracy assessment in ExcelsiusGPS® robotic spine surgery: evaluation of deviation from pre-planned trajectory
Tóm tắt
The ExcelsiusGPS® (Globus Medical, Inc., Audubon, PA) is a next-generation spine surgery robotic system recently approved for use in the United States. The objective of the current study is to assess pedicle screw accuracy and clinical outcomes among two of the first operative cases utilizing the ExcelsiusGPS® robotic system and describe a novel metric to quantify screw deviation. Two patients who underwent lumbar fusion at a single institution with the ExcelsiusGPS® surgical robot were included. Pre-operative trajectory planning was performed from an intra-operative CT scan using the O-arm (Medtronic, Inc., Minneapolis, MN). After robotic-assisted screw implantation, a post-operative CT scan was obtained to confirm ideal screw placement and accuracy with the planned trajectory. A novel pedicle screw accuracy algorithm was devised to measure screw tip/tail deviation distance and angular offset on axial and sagittal planes. Screw accuracy was concurrently determined by a blinded neuroradiologist using the traditional Gertzbein-Robbins method. Clinical variables such as symptomatology, operative data, and post-operative follow-up were also collected. Eight pedicle screws were placed in two L4-L5 fusion cases. Mean screw tip deviation was 2.1 mm (range 0.8–5.2 mm), mean tail deviation was 3.2 mm (range 0.9–5.4 mm), and mean angular offset was 2.4 degrees (range 0.7–3.8 degrees). All eight screws were accurately placed based on the Gertzbein-Robbins scale (88% Grade A and 12% Grade B). There were no cases of screw revision or new post-operative deficit. Both patients experienced improvement in Frankel grade and Karnofsky Performance Status (KPS) score by 6 weeks post-op. The ExcelsiusGPS® robot allows for precise execution of an intended pre-planned trajectory and accurate screw placement in the first patients to undergo robotic-assisted fusion with this technology.
Tài liệu tham khảo
Bertelsen A, Melo J, Sanchez E, Borro D. A review of surgical robots for spinal interventions. Int J Med Robot. 2013;9(4):407–22.
Onen MR, Naderi S. Robotic systems in spine surgery. Turk Neurosurg. 2014;24(3):305–11.
Overley SC, Cho SK, Mehta AI, Arnold PM. Navigation and robotics in spinal surgery: where are we now? Neurosurgery. 2017;80(3S):S86–99.
Bindal RK, Glaze S, Ognoskie M, Tunner V, Malone R, Ghosh S. Surgeon and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion. J Neurosurg Spine. 2008;9(6):570–3.
Doulgeris JJ, Gonzalez-Blohm SA, Filis AK, Shea TM, Aghayev K, Vrionis FD. Robotics in neurosurgery: evolution, current challenges, and compromises. Cancer Control. 2015;22(3):352–9.
Dreval ON, Rynkov IP, Kasparova KA, Bruskin A, Aleksandrovskii V, Zil’bernshtein V. Results of using spine assist Mazor in surgical treatment of spine disorders. Zh Vopr Neirokhir Im N N Burdenko. 2014;78(3):14–20.
Joseph JR, Smith BW, Liu X, Park P. Current applications of robotics in spine surgery: a systematic review of the literature. Neurosurg Focus. 2017;42(5):E2.
Lieberman IH, Togawa D, Kayanja MM, Reinhardt MK, Friedlander A, Knoller N, Benzel EC. Bone-mounted miniature robotic guidance for pedicle screw and translaminar facet screw placement: part I--technical development and a test case result. Neurosurgery. 2006;59(3):641–50. discussion 641-650
Lefranc M, Peltier J. Evaluation of the ROSA spine robot for minimally invasive surgical procedures. Expert Rev Med Devices. 2016;13(10):899–906.
Chenin L, Capel C, Fichten A, Peltier J, Lefranc M. Evaluation of screw placement accuracy in circumferential lumbar arthrodesis using robotic assistance and intraoperative flat-panel computed tomography. World Neurosurg. 2017;105:86–94.
Fan Y, Du JP, Liu JJ, Zhang JN, Qiao HH, Liu SC, Hao DJ. Accuracy of pedicle screw placement comparing robot-assisted technology and the free-hand with fluoroscopy-guided method in spine surgery: an updated meta-analysis. Medicine (Baltimore). 2018;97(22):e10970.
Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976). 1990;15(1):11–4.
Kantelhardt SR, Martinez R, Baerwinkel S, Burger R, Giese A, Rohde V. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J. 2011;20(6):860–8.
Marcus HJ, Cundy TP, Nandi D, Yang GZ, Darzi A. Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review. Eur Spine J. 2014;23(2):291–7.
van Dijk JD, van den Ende RP, Stramigioli S, Kochling M, Hoss N. Clinical pedicle screw accuracy and deviation from planning in robot-guided spine surgery: robot-guided pedicle screw accuracy. Spine (Phila Pa 1976). 2015;40(17):E986–91.
Molliqaj G, Schatlo B, Alaid A, Solomiichuk V, Rohde V, Schaller K, Tessitore E. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus. 2017;42(5):E14.
Solomiichuk V, Fleischhammer J, Molliqaj G, Warda J, Alaid A, von Eckardstein K, Schaller K, Tessitore E, Rohde V, Schatlo B. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison. Neurosurg Focus. 2017;42(5):E13.
Schatlo B, Molliqaj G, Cuvinciuc V, Kotowski M, Schaller K, Tessitore E. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. J Neurosurg Spine. 2014;20(6):636–43.
Wiesner L, Kothe R, Ruther W. Anatomic evaluation of two different techniques for the percutaneous insertion of pedicle screws in the lumbar spine. Spine (Phila Pa 1976). 1999;24(15):1599–603.
Rampersaud YR, Pik JH, Salonen D, Farooq S. Clinical accuracy of fluoroscopic computer-assisted pedicle screw fixation: a CT analysis. Spine (Phila Pa 1976). 2005;30(7):E183–90.
Neo M, Sakamoto T, Fujibayashi S, Nakamura T. The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine (Phila Pa 1976). 2005;30(24):2800–5.
Devito DP, Kaplan L, Dietl R, Pfeiffer M, Horne D, Silberstein B, Hardenbrook M, Kiriyanthan G, Barzilay Y, Bruskin A, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976). 2010;35(24):2109–15.
Tsai TH, Wu DS, Su YF, Wu CH, Lin CL. A retrospective study to validate an intraoperative robotic classification system for assessing the accuracy of kirschner wire (K-wire) placements with postoperative computed tomography classification system for assessing the accuracy of pedicle screw placements. Medicine (Baltimore). 2016;95(38):e4834.