Pedicle screw accuracy in clinical utilization of minimally invasive navigated robot-assisted spine surgery
Tóm tắt
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.
Tài liệu tham khảo
Parker SL, McGirt MJ, Farber SH et al (2011) Accuracy of free-hand pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws. Neurosurgery. 68(1):170–178
Hicks JM, Singla A, Shen FH, Arlet V (2010) Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine. 35(11):E465–470
Ledonio CG, Polly DW Jr, Vitale MG, Wang Q, Richards BS (2011) Pediatric pedicle screws: comparative effectiveness and safety: a systematic literature review from the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America task force. J Bone Jt Surg Am Vol. 93(13):1227–1234
Amato V, Giannachi L, Irace C, Corona C (2010) Accuracy of pedicle screw placement in the lumbosacral spine using conventional technique: computed tomography postoperative assessment in 102 consecutive patients. J Neurosurg Spine. 12(3):306–313
Van de Kelft E, Costa F, Van der Planken D, Schils F (2012) A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation. Spine. 37(25):E1580–1587
Tian NF, Huang QS, Zhou P et al (2011) Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur Spine J. 20(6):846–859
Dinesh SK, Tiruchelvarayan R, Ng I (2012) A prospective study on the use of intraoperative computed tomography (iCT) for image-guided placement of thoracic pedicle screws. Br J Neurosurg 26(6):838–844
Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine. 29(3):333–342
van Dijk JD, van den Ende RP, Stramigioli S, Kochling M, Hoss N (2015) Clinical pedicle screw accuracy and deviation from planning in robot-guided spine surgery: robot-guided pedicle screw accuracy. Spine. 40(17):E986–991
Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine. 15(1):11–14
Khan A, Meyers JE, Siasios I, Pollina J (2018) Next-generation robotic spine surgery: first report on feasibility, safety, and learning curve. Oper Neurosurg (Hagerstown, Md). 17:61–69
Shin BJ, James AR, Njoku IU, Hartl R (2012) Pedicle screw navigation: a systematic review and meta-analysis of perforation risk for computer-navigated versus freehand insertion. J Neurosurg Spine. 17(2):113–122
Ghasem A, Sharma A, Greif DN, Alam M, Maaieh MA (2018) The arrival of robotics in spine surgery: a review of the literature. Spine. 43(23):1670–1677
Kosmopoulos V, Schizas C (2007) Pedicle screw placement accuracy: a meta-analysis. Spine. 32(3):E111–120
Kosmopoulos V, Theumann N, Binaghi S, Schizas C (2007) Observer reliability in evaluating pedicle screw placement using computed tomography. Int Orthop 31(4):531–536
Meng XT, Guan XF, Zhang HL, He SS (2016) Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw placement: a meta-analysis. Neurosurg Rev 39(3):385–391
Gelalis ID, Paschos NK, Pakos EE et al (2012) Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J. 21(2):247–255
Elmi-Terander A, Skulason H, Söderman M et al (2016) Surgical navigation technology based on augmented reality and integrated 3D intraoperative imaging: a spine cadaveric feasibility and accuracy study. Spine. 41(21):E1303–E1311
Sarwahi V, Payares M, Wendolowski S et al (2017) Pedicle screw safety: how much anterior breach is safe?: a cadaveric and CT-based study. Spine. 42(22):E1305–e1310
Jain A, Hassanzadeh H, Strike SA, Menga EN, Sponseller PD, Kebaish KM (2015) Pelvic fixation in adult and pediatric spine surgery: historical perspective, indications, and techniques: AAOS exhibit selection. J Bone J Surg Am Vol. 97(18):1521–1528