Placement of LC-II and trans-sacral screws using a robotic arm in a simulated bone model in the supine position – a feasibility study

Journal of Experimental Orthopaedics - 2022
Jon B. Carlson1, Jiyao Zou1, Brandi Hartley1
1Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson St 1st Floor ACB, Louisville, KY, 40292, USA

Tóm tắt

Abstract Purpose The use of a robotic arm has been well-described in the literature for the placement of pedicle screws in spine surgery as well as implants for sacroiliac joint fusion. There are no reports describing the use of a robotic arm to place screws in osseous fixation pathways (OFPs) employed in the treatment of pelvic ring and acetabular fractures outside of a single center in China. Using a Sawbones model, the authors describe a technique for using a robotic arm widely available in Europe and the Americas for placement of 6.5 mm cannulated screws into two OFPs commonly used in the treatment of pelvic and acetabular fractures. Methods Using the Mazor X Stealth Edition (MSXE) robot from Medtronic, the authors were able to place a pin into the pelvis onto which the robot was docked. The authors were then able to designate the area of interest using navigated instruments, and in combination with the MSXE “scan and plan” marker, obtain cross-sectional imaging using the O-Arm and successfully register the MSXE robot. We then used the provided software to plan trajectories for the lateral compression type 2 (LC-II) screw pathway as well as a pathway for a trans-ilio-trans-sacral screw. We describe in detail the steps for setup, planning and placement of 6.5 mm cannulated screws using the MSXE robotic arm into these two OFPs. Results Visual inspection and plain x-rays demonstrated successful placement of the screws into the two planned OFPs. No breach of cortical bone was seen on either visual inspection of the model or demonstrated on post-procedure x-rays. Conclusion It is possible to use the Mazor X Stealth Edition robot to place screws into the LC-II and trans-ilio-transsacral screw pathways in a Sawbones model. This is only a feasibility study, and should in no way be taken to suggest that clinical application of this technique should be attempted.

Từ khóa


Tài liệu tham khảo

Porter SE, Russell GV, Qin Z, Graves ML (2008) Operative fixation of acetabular fractures in the pregnant patient. J Orthop Trauma 22:508–516. https://doi.org/10.1097/BOT.0b013e3181847a42

Krappinger D, Lindtner RA, Benedikt S (2019) Preoperative planning and safe intraoperative placement of iliosacral screws under fluoroscopic control. Oper Orthop Traumatol 31:465–473. https://doi.org/10.1007/s00064-019-0612-x

Banaszek D, Starr AJ, Lefaivre KA (2019) Technical considerations and fluoroscopy in percutaneous fixation of the pelvis and acetabulum. J Am Acad Orthop Surg 27:899–908. https://doi.org/10.5435/JAAOS-D-18-00102

Zwingmann J, Hauschild O, Bode G et al (2013) Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 133:1257–1265. https://doi.org/10.1007/s00402-013-1788-4

Hu X, Lieberman IH (2017) Robotic-guided sacro-pelvic fixation using S2 alar-iliac screws: feasibility and accuracy. Eur Spine J 26:720–725. https://doi.org/10.1007/s00586-016-4639-5

Laratta JL, Shillingford JN, Lombardi JM et al (2018) Accuracy of S2 alar-iliac screw placement under robotic guidance. Spine Deform 6:130–136. https://doi.org/10.1016/j.jspd.2017.08.009

Devito DP, Kaplan L, Dietl R et al (2010) Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976) 35:2109–2115. https://doi.org/10.1097/BRS.0b013e3181d323ab

Marcus HJ, Cundy TP, Nandi D et al (2014) Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review. Eur Spine J 23:291–297. https://doi.org/10.1007/s00586-013-2879-1

Schatlo B, Molliqaj G, Cuvinciuc V et al (2014) 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 20:636–643. https://doi.org/10.3171/2014.3.SPINE13714

Molliqaj G, Schatlo B, Alaid A et al (2017) Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus 42:E14. https://doi.org/10.3171/2017.3.FOCUS179

Peng Y-N, Tsai L-C, Hsu H-C, Kao C-H (2020) Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials. Ann Transl Med 8:824. https://doi.org/10.21037/atm-20-1106

Liu H-S, Duan S-J, Xin F-Z et al (2019) Robot-assisted minimally-invasive internal fixation of pelvic ring injuries: a single-center experience. Orthop Surg 11:42–51. https://doi.org/10.1111/os.12423

Buza JA, Good CR, Lehman RA et al (2021) Robotic-assisted cortical bone trajectory (CBT) screws using the Mazor X stealth edition (MXSE) system: workflow and technical tips for safe and efficient use. J Robot Surg 15:13–23. https://doi.org/10.1007/s11701-020-01147-7

Thông tin
Thông tin xuất bản

Journal of Experimental Orthopaedics

Thông tin tác giả