1
|
Ao Y, Esfandiari H, Carrillo F, Laux CJ, As Y, Li R, Van Assche K, Davoodi A, Cavalcanti NA, Farshad M, Grewe BF, Vander Poorten E, Krause A, Fürnstahl P. SafeRPlan: Safe deep reinforcement learning for intraoperative planning of pedicle screw placement. Med Image Anal 2024; 99:103345. [PMID: 39293187 DOI: 10.1016/j.media.2024.103345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 07/11/2024] [Accepted: 09/08/2024] [Indexed: 09/20/2024]
Abstract
Spinal fusion surgery requires highly accurate implantation of pedicle screw implants, which must be conducted in critical proximity to vital structures with a limited view of the anatomy. Robotic surgery systems have been proposed to improve placement accuracy. Despite remarkable advances, current robotic systems still lack advanced mechanisms for continuous updating of surgical plans during procedures, which hinders attaining higher levels of robotic autonomy. These systems adhere to conventional rigid registration concepts, relying on the alignment of preoperative planning to the intraoperative anatomy. In this paper, we propose a safe deep reinforcement learning (DRL) planning approach (SafeRPlan) for robotic spine surgery that leverages intraoperative observation for continuous path planning of pedicle screw placement. The main contributions of our method are (1) the capability to ensure safe actions by introducing an uncertainty-aware distance-based safety filter; (2) the ability to compensate for incomplete intraoperative anatomical information, by encoding a-priori knowledge of anatomical structures with neural networks pre-trained on pre-operative images; and (3) the capability to generalize over unseen observation noise thanks to the novel domain randomization techniques. Planning quality was assessed by quantitative comparison with the baseline approaches, gold standard (GS) and qualitative evaluation by expert surgeons. In experiments with human model datasets, our approach was capable of achieving over 5% higher safety rates compared to baseline approaches, even under realistic observation noise. To the best of our knowledge, SafeRPlan is the first safety-aware DRL planning approach specifically designed for robotic spine surgery.
Collapse
Affiliation(s)
- Yunke Ao
- ROCS, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; Department of Computer Science, ETH Zurich, Universitätstrasse 6, 8092 Zürich, Switzerland; ETH AI Center, ETH Zürich, Andreasstrasse 5, 8092 Zürich, Switzerland.
| | - Hooman Esfandiari
- ROCS, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Fabio Carrillo
- ROCS, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Christoph J Laux
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Yarden As
- Department of Computer Science, ETH Zurich, Universitätstrasse 6, 8092 Zürich, Switzerland; ETH AI Center, ETH Zürich, Andreasstrasse 5, 8092 Zürich, Switzerland
| | - Ruixuan Li
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3001 Leuven, Belgium
| | - Kaat Van Assche
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3001 Leuven, Belgium
| | - Ayoob Davoodi
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300, 3001 Leuven, Belgium
| | - Nicola A Cavalcanti
- ROCS, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Benjamin F Grewe
- Department of Information Technology and Electrical Engineering, ETH Zurich, Gloriastrasse 35, 8092 Zürich, Switzerland; ETH AI Center, ETH Zürich, Andreasstrasse 5, 8092 Zürich, Switzerland
| | | | - Andreas Krause
- Department of Computer Science, ETH Zurich, Universitätstrasse 6, 8092 Zürich, Switzerland; ETH AI Center, ETH Zürich, Andreasstrasse 5, 8092 Zürich, Switzerland
| | - Philipp Fürnstahl
- ROCS, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; ETH AI Center, ETH Zürich, Andreasstrasse 5, 8092 Zürich, Switzerland
| |
Collapse
|
2
|
Nilssen PK, Narendran N, Skaggs DL, Tuchman A, Walker CT, Perry TG. Comparison of rostral facet joint violations in robotic- and navigation-assisted pedicle screw placement for adult lumbar spine instrumentation. Spine J 2024:S1529-9430(24)00925-2. [PMID: 39142354 DOI: 10.1016/j.spinee.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/23/2024] [Accepted: 07/29/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND CONTEXT Facet joint violation by pedicle screws may lead to adjacent-segment disease and postoperative pain. Previous studies have reported the incidence of rostral facet joint violation using various pedicle screw insertion techniques. However, the incidence of facet joint violations with robotic guidance has not been determined. PURPOSE To investigate and compare the incidence of rostral facet joint violation by pedicle screws under robotic guidance and computerized tomography (CT) navigation guidance. STUDY DESIGN/SETTING Retrospective matched cohort. PATIENT SAMPLE All patients who underwent robotic-assisted lumbar fusion at a major spine center up until 2023 were retrospectively identified and matched 1:3 to patients undergoing CT navigation guidance based by on age, sex, rostral vertebral level, and length of construct. Inclusion criteria consisted of age greater than 18 years, bilateral pedicle screw fixation, and presence of a postoperative CT scan of the lumbar spine or abdomen/pelvis at any point in the post-operative period. OUTCOME MEASURES Rostral facet joint violations. METHODS Descriptive statistics were used to compare cohorts: frequencies, chi-squared analysis for categorical variables, and t-test for continuous variables. RESULTS A total of 408 rostral pedicle screws were implanted in 204 patients (Robot: 102; Navigation: 306). Overall, 13 (12.3%) rostral facet joint violations were observed in the robot cohort and 75 (24.5%) in the navigation cohort (p=.01). Specifically, fewer robotic violations were observed at the L2 (3.5% vs. 32.1%, p=.003) and L3 levels (3.9% vs. 18.1%, p=.08) compared to navigation. No difference was observed at L4 and L5. Bilateral violations are significantly reduced with robotic approaches (5.3% vs. 14.4%, p=.03). Lastly, more facet joint violations were observed during open approaches (robot: 18.8%, navigation: 27.3%) than percutaneous approaches (robot: 11.6%, navigation: 7.1%) in both groups (p<.001). The rate of L4 facet violations was 18.8% in the robotic cohort and 27.3% in the navigation cohort. The rate of L5 facet violations was 31.3% in the robotic cohort and 29.2% in the navigation cohort. CONCLUSIONS Use of robotic assistance in lumbar pedicle screws significantly reduced the rate of rostral facet joint violations compared to navigation guidance at L2 and L3 levels, but not at L4 and L5, with facet violations approaching nearly one-third of the patients at L5 screws. Rostral facet violations can play a significant role in adjacent segment degeneration and disease. Technical factors and trajectory issues likely play a role and addressing these components should minimize unintended facet violation and proximal adding on.
Collapse
Affiliation(s)
- Paal K Nilssen
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nakul Narendran
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - David L Skaggs
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Alexander Tuchman
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Corey T Walker
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Tiffany G Perry
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| |
Collapse
|
3
|
Liu X, Liu F, Jin L, Wu J. Evolution of Neurosurgical Robots: Historical Progress and Future Direction. World Neurosurg 2024; 191:49-57. [PMID: 39116942 DOI: 10.1016/j.wneu.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
In 1985, Professor KWOH first introduced robots into neurosurgery. Since then, advancements of stereotactic frames, radiographic imaging, and neuronavigation have led to the dominance of classic stereotactic robots. A comprehensive retrieval was performed using academic databases and search agents to acquire professional information, with a cutoff date of June, 2024. This reveals a multitude of emerging technologies are coming to the forefront, including tremor filtering, motion scaling, obstacle avoidance, force sensing, which have made significant contributions to the high efficiency, high precision, minimally invasive, and exact efficacy of robot-assisted neurosurgery. Those technologies have been applied in innovative magnetic resonance-compatible neurosurgical robots, such as Neuroarm and Neurobot, with real-time image-guided surgery. Despite these advancements, the major challenge is considered as magnetic resonance compatibility in terms of space, materials, driving, and imaging. Future research directions are anticipated to focus on 1) robotic precise perception; 2) artificial intelligence; and 3) the advancement of telesurgery.
Collapse
Affiliation(s)
- Xi Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China
| | - Feili Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China
| | - Lei Jin
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China.
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China
| |
Collapse
|
4
|
Komolafe TE, Zhou L, Zhao W, Guo J, Li Z, Fan Z, Komolafe BF, Wei W, Samuel OW. Advancing robot-guided techniques in lumbar spine surgery: a systematic review and meta-analysis. Expert Rev Med Devices 2024; 21:765-779. [PMID: 39007890 DOI: 10.1080/17434440.2024.2378080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/04/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Lumbar spine surgery is a crucial intervention for addressing spinal injuries or conditions affecting the spine, often involving lumbar fusion through pedicle screw (PS) insertion. The precision of PS placement is pivotal in orthopedic surgery. This systematic review compares the accuracy of robot-guided (RG) surgery with free-hand fluoroscopy-guided (FFG), free-hand without fluoroscopy-guided (FHG), and computed tomography image-guided (CTG) techniques for PS insertion. METHODS A systematic search of various databases from 1 January 2013 to 30 December 2023 was conducted following PRISMA guidelines. Primary outcomes, including PS insertion accuracy and breach rate, were analyzed using a random-effects model. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS The overall accuracy of PS insertion using RG, based on 37 studies involving 3,837 patients and 22,117 PS, is 97.9%, with a breach rate of 0.021. RG demonstrated superior accuracy compared to FHG and CTG, with breach rates of 3.4 and 0.015 respectively for RG versus FHG, and 3.8 and 0.026 for RG versus CTG. Additionally, RG was associated with reduced mean estimated blood loss compared to CTG, indicating improved safety. CONCLUSIONS The RG is associated with enhanced accuracy of PS insertion and reduced breach rates over other methods. However, additional randomized controlled trials comparing these modalities are needed for further validation. PROSPERO REGISTRATION CRD42023483997.
Collapse
Affiliation(s)
| | - Liang Zhou
- Department of Radiology, Jiading District Central Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
- Biomedical Engineering Fusion Laboratory, Jiangning Hospital Affiliated with Nanjing Medical University, Nanjing, China
| | - Wenlong Zhao
- Collaborative Research Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jiachen Guo
- Collaborative Research Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Zongdao Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhiping Fan
- Collaborative Research Center, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Blessing Funmi Komolafe
- School of International Education, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Wang Wei
- Department of Orthopaedic, School of Medicine, Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | | |
Collapse
|
5
|
Maman D, Mahamid A, Finkel B, Gan-Or H, Fournier L, Berkovich Y, Behrbalk E. Comparative evaluation of postoperative outcomes and expenditure between robotic and conventional single-level lumbar fusion surgery: a comprehensive analysis of nationwide inpatient sample data. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2637-2645. [PMID: 38713445 DOI: 10.1007/s00586-024-08273-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION In this study, we investigate the evolution of lumbar fusion surgery with robotic assistance, specifically focusing on the impact of robotic technology on pedicle screw placement and fixation. Utilizing data from the Nationwide Inpatient Sample (NIS) covering 2016 to 2019, we conduct a comprehensive analysis of postoperative outcomes and costs for single-level lumbar fusion surgery. Traditionally, freehand techniques for pedicle screw placement posed risks, leading to the development of robotic-assisted techniques with advantages such as reduced misplacement, increased precision, smaller incisions, and decreased surgeon fatigue. However, conflicting study results regarding the efficacy of robotic assistance in comparison to conventional techniques have prompted the need for a thorough evaluation. With a dataset of 461,965 patients, our aim is to provide insights into the impact of robotic assistance on patient care and healthcare resource utilization. Our primary goal is to contribute to the ongoing discourse on the efficacy of robotic technology in lumbar fusion procedures, offering meaningful insights for optimizing patient-centered care and healthcare resource allocation. METHODS This study employed data from the Nationwide Inpatient Sample (NIS) spanning the years 2016 to 2019 from USA, 461,965 patients underwent one-level lumbar fusion surgery, with 5770 of them having the surgery with the assistance of robotic technology. The study focused primarily on one-level lumbar fusion surgery and excluded non-elective cases and those with prior surgeries. The analysis encompassed the identification of comorbidities, surgical etiologies, and complications using specific ICD-10 codes. Throughout the study, a constant comparison was made between robotic and non-robotic lumbar fusion procedures. Various statistical methods were applied, with a p value threshold of < 0.05, to determine statistical significance. RESULTS Robotic-assisted lumbar fusion surgeries demonstrated a significant increase from 2016 to 2019, comprising 1.25% of cases. Both groups exhibited similar patient demographics, with minor differences in payment methods, favoring Medicare in non-robotic surgery and more private payer usage in robotic surgery. A comparison of comorbid conditions revealed differences in the prevalence of hypertension, dyslipidemia, and sleep apnea diagnoses-In terms of hospitalization outcomes and costs, there was a slight shorter hospital stay of 3.06 days, compared to 3.13 days in non-robotic surgery, showcasing a statistically significant difference (p = 0.042). Robotic surgery has higher charges, with a mean charge of $154,673, whereas non-robotic surgery had a mean charge of $125,467 (p < 0.0001). Robotic surgery demonstrated lower rates of heart failure, acute coronary artery disease, pulmonary edema, venous thromboembolism, and traumatic spinal injury compared to non-robotic surgery, with statistically significant differences (p < 0.05). Conversely, robotic surgery demonstrated increased post-surgery anemia and blood transfusion requirements compared to non-robotic patients (p < 0.0001). Renal disease prevalence was similar before surgery, but acute kidney injury was slightly higher in the robotic group post-surgery (p = 0.038). CONCLUSION This is the first big data study on this matter, our study showed that Robotic-assisted lumbar fusion surgery has fewer post-operative complications such as heart failure, acute coronary artery disease, pulmonary edema, venous thromboembolism, and traumatic spinal injury in comparison to conventional methods. Conversely, robotic surgery demonstrated increased post-surgery anemia, blood transfusion and acute kidney injury. Robotic surgery has higher charges compared to non-robotic surgery.
Collapse
Affiliation(s)
- David Maman
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel.
| | - Assil Mahamid
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
| | - Binyamin Finkel
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
| | - Hadar Gan-Or
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
| | | | - Yaron Berkovich
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
- Technion Israel Institute of Technology, Haifa, Israel
| | - Eyal Behrbalk
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
- Technion Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
6
|
Cui W, Liu X, Zhao Z, Feng Z, Meng X. Accuracy and postoperative assessment of robot-assisted placement of pedicle screws during scoliosis surgery compared with conventional freehand technique: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:365. [PMID: 38902785 PMCID: PMC11188284 DOI: 10.1186/s13018-024-04848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
STUDY DESIGN A systematic review and meta-analysis. BACKGROUND The complexity of human anatomical structures and the variability of vertebral body structures in patients with scoliosis pose challenges in pedicle screw placement during spinal deformity correction surgery. Through technological advancements, robots have been introduced in spinal surgery to assist with pedicle screw placement. METHODS A systematic search was conducted using PubMed, Cochrane, Embase, and CNKI databases and comparative studies assessing the accuracy and postoperative efficacy of pedicle screw placement using robotic assistance or freehand techniques in patients with scoliosis were included. The analysis evaluated the accuracy of screw placement, operative duration, intraoperative blood loss, length of postoperative hospital stay, and complications. RESULTS Seven studies comprising 584 patients were included in the meta-analysis, with 282 patients (48.3%) in the robot-assisted group and 320 (51.7%) in the freehand group. Robot-assisted placement showed significantly better clinically acceptable screw placement results compared with freehand placement (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.75-3.91, P < 0.0001). However, there were no statistically significant differences in achieving "perfect" screw placement between the two groups (OR: 1.52, 95% CI: 0.95-2.46, P = 0.08). The robot-assisted group had longer operation durations (mean deviation [MD]: 43.64, 95% CI: 22.25-64.74, P < 0.0001) but shorter postoperative hospital stays (MD: - 1.12, 95% CI: - 2.15 to - 0.08, P = 0.03) than the freehand group. There were no significant differences in overall complication rates or intraoperative blood loss between the two groups. There was no significant difference in Cobb Angle between the two groups before and after operation. CONCLUSION Robot-assisted pedicle screw placement offers higher accuracy and shorter hospital stay than freehand placement in scoliosis surgery; although the robotics approach is associated with longer operative durations, similar complication rates and intraoperative blood loss.
Collapse
Affiliation(s)
- Wei Cui
- Department of Orthopedic Surgery, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xinglin Liu
- Department of Orthopedic Surgery, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Zhiheng Zhao
- Department of Orthopedic Surgery, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Zihe Feng
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, S Sanlitun Rd, Chaoyang District, Beijing, 100020, China
| | - Xianglong Meng
- Department of Orthopedic Surgery, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| |
Collapse
|
7
|
Yuan S, Chen R, Zang L, Wang A, Fan N, Du P, Xi Y, Wang T. Development of a software system for surgical robots based on multimodal image fusion: study protocol. Front Surg 2024; 11:1389244. [PMID: 38903864 PMCID: PMC11187239 DOI: 10.3389/fsurg.2024.1389244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/29/2024] [Indexed: 06/22/2024] Open
Abstract
Background Surgical robots are gaining increasing popularity because of their capability to improve the precision of pedicle screw placement. However, current surgical robots rely on unimodal computed tomography (CT) images as baseline images, limiting their visualization to vertebral bone structures and excluding soft tissue structures such as intervertebral discs and nerves. This inherent limitation significantly restricts the applicability of surgical robots. To address this issue and further enhance the safety and accuracy of robot-assisted pedicle screw placement, this study will develop a software system for surgical robots based on multimodal image fusion. Such a system can extend the application range of surgical robots, such as surgical channel establishment, nerve decompression, and other related operations. Methods Initially, imaging data of the patients included in the study are collected. Professional workstations are employed to establish, train, validate, and optimize algorithms for vertebral bone segmentation in CT and magnetic resonance (MR) images, intervertebral disc segmentation in MR images, nerve segmentation in MR images, and registration fusion of CT and MR images. Subsequently, a spine application model containing independent modules for vertebrae, intervertebral discs, and nerves is constructed, and a software system for surgical robots based on multimodal image fusion is designed. Finally, the software system is clinically validated. Discussion We will develop a software system based on multimodal image fusion for surgical robots, which can be applied to surgical access establishment, nerve decompression, and other operations not only for robot-assisted nail placement. The development of this software system is important. First, it can improve the accuracy of pedicle screw placement, percutaneous vertebroplasty, percutaneous kyphoplasty, and other surgeries. Second, it can reduce the number of fluoroscopies, shorten the operation time, and reduce surgical complications. In addition, it would be helpful to expand the application range of surgical robots by providing key imaging data for surgical robots to realize surgical channel establishment, nerve decompression, and other operations.
Collapse
Affiliation(s)
| | | | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | | |
Collapse
|
8
|
Wang C, Guo L, Zhu J, Zhu L, Li C, Zhu H, Song A, Lu L, Teng GJ, Navab N, Jiang Z. Review of robotic systems for thoracoabdominal puncture interventional surgery. APL Bioeng 2024; 8:021501. [PMID: 38572313 PMCID: PMC10987197 DOI: 10.1063/5.0180494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Cancer, with high morbidity and high mortality, is one of the major burdens threatening human health globally. Intervention procedures via percutaneous puncture have been widely used by physicians due to its minimally invasive surgical approach. However, traditional manual puncture intervention depends on personal experience and faces challenges in terms of precisely puncture, learning-curve, safety and efficacy. The development of puncture interventional surgery robotic (PISR) systems could alleviate the aforementioned problems to a certain extent. This paper attempts to review the current status and prospective of PISR systems for thoracic and abdominal application. In this review, the key technologies related to the robotics, including spatial registration, positioning navigation, puncture guidance feedback, respiratory motion compensation, and motion control, are discussed in detail.
Collapse
Affiliation(s)
- Cheng Wang
- Hanglok-Tech Co. Ltd., Hengqin 519000, People's Republic of China
| | - Li Guo
- Hanglok-Tech Co. Ltd., Hengqin 519000, People's Republic of China
| | | | - Lifeng Zhu
- State Key Laboratory of Digital Medical Engineering, Jiangsu Key Lab of Remote Measurement and Control, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, People's Republic of China
| | - Chichi Li
- School of Computer Science and Engineering, Macau University of Science and Technology, Macau, 999078, People's Republic of China
| | - Haidong Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, People's Republic of China
| | - Aiguo Song
- State Key Laboratory of Digital Medical Engineering, Jiangsu Key Lab of Remote Measurement and Control, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, People's Republic of China
| | | | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, People's Republic of China
| | | | - Zhongliang Jiang
- Computer Aided Medical Procedures, Technical University of Munich, Munich 80333, Germany
| |
Collapse
|
9
|
Drossopoulos PN, Sharma A, Ononogbu-Uche FC, Tabarestani TQ, Bartlett AM, Wang TY, Huie D, Gottfried O, Blitz J, Erickson M, Lad SP, Bullock WM, Shaffrey CI, Abd-El-Barr MM. Pushing the Limits of Minimally Invasive Spine Surgery-From Preoperative to Intraoperative to Postoperative Management. J Clin Med 2024; 13:2410. [PMID: 38673683 PMCID: PMC11051300 DOI: 10.3390/jcm13082410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
The introduction of minimally invasive surgery ushered in a new era of spine surgery by minimizing the undue iatrogenic injury, recovery time, and blood loss, among other complications, of traditional open procedures. Over time, technological advancements have further refined the care of the operative minimally invasive spine patient. Moreover, pre-, and postoperative care have also undergone significant change by way of artificial intelligence risk stratification, advanced imaging for surgical planning and patient selection, postoperative recovery pathways, and digital health solutions. Despite these advancements, challenges persist necessitating ongoing research and collaboration to further optimize patient care in minimally invasive spine surgery.
Collapse
Affiliation(s)
- Peter N. Drossopoulos
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Arnav Sharma
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Favour C. Ononogbu-Uche
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Troy Q. Tabarestani
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Alyssa M. Bartlett
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Timothy Y. Wang
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - David Huie
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Oren Gottfried
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Jeanna Blitz
- Department of Anesthesiology, Duke University, Durham, NC 27710, USA (W.M.B.)
| | - Melissa Erickson
- Division of Spine, Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Shivanand P. Lad
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - W. Michael Bullock
- Department of Anesthesiology, Duke University, Durham, NC 27710, USA (W.M.B.)
| | - Christopher I. Shaffrey
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Muhammad M. Abd-El-Barr
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| |
Collapse
|
10
|
Davidar AD, Jiang K, Weber-Levine C, Bhimreddy M, Theodore N. Advancements in Robotic-Assisted Spine Surgery. Neurosurg Clin N Am 2024; 35:263-272. [PMID: 38423742 DOI: 10.1016/j.nec.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Applications and workflows around spinal robotics have evolved since these systems were first introduced in 2004. Initially approved for lumbar pedicle screw placement, the scope of robotics has expanded to instrumentation across different regions. Additionally, precise navigation can aid in tumor resection or spinal lesion ablation. Robot-assisted surgery can improve accuracy while decreasing radiation exposure, length of hospital stay, complication, and revision rates. Disadvantages include increased operative time, dependence on preoperative imaging among others. The future of robotic spine surgery includes automated surgery, telerobotic surgery, and the inclusion of machine learning or artificial intelligence in preoperative planning.
Collapse
Affiliation(s)
- A Daniel Davidar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carly Weber-Levine
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meghana Bhimreddy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Orthopaedic Surgery & Biomedical Engineering, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
11
|
von Atzigen M, Liebmann F, Cavalcanti NA, Anh Baran T, Wanivenhaus F, Spirig JM, Rauter G, Snedeker J, Farshad M, Fürnstahl P. Reducing residual forces in spinal fusion using a custom-built rod bending machine. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 247:108096. [PMID: 38447314 DOI: 10.1016/j.cmpb.2024.108096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND OBJECTIVE As part of spinal fusion surgery, shaping the rod implant to align with the anatomy is a tedious, error-prone, and time-consuming manual process. Inadequately contoured rod implants introduce stress on the screw-bone interface of the pedicle screws, potentially leading to screw loosening or even pull-out. METHODS We propose the first fully automated solution to the rod bending problem by leveraging the advantages of augmented reality and robotics. Augmented reality not only enables the surgeons to intraoperatively digitize the screw positions but also provides a human-computer interface to the wirelessly integrated custom-built rod bending machine. Furthermore, we introduce custom-built test rigs to quantify per screw absolute tensile/compressive residual forces on the screw-bone interface. Besides residual forces, we have evaluated the required bending times and reducer engagements, and compared our method to the freehand gold standard. RESULTS We achieved a significant reduction of the average absolute residual forces from for the freehand gold standard to (p=0.0015) using the bending machine. Moreover, our bending machine reduced the average time to instrumentation per screw from to . Reducer engagements per rod were significantly decreased from an average of 1.00±1.14 to 0.11±0.32 (p=0.0037). CONCLUSION The combination of augmented reality and robotics has the potential to improve surgical outcomes while minimizing the dependency on individual surgeon skill and dexterity.
Collapse
Affiliation(s)
- Marco von Atzigen
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Laboratory for Orthopaedic Biomechanics, ETH Zurich, Zurich, Switzerland.
| | - Florentin Liebmann
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Laboratory for Orthopaedic Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Nicola A Cavalcanti
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - The Anh Baran
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Computer Aided Medical Procedures (CAMP), Technical University of Munich, Munich, Germany
| | - Florian Wanivenhaus
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - José Miguel Spirig
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Georg Rauter
- Bio-Inspired RObots for MEDicine-Lab, University of Basel, Basel, Switzerland
| | - Jess Snedeker
- Laboratory for Orthopaedic Biomechanics, ETH Zurich, Zurich, Switzerland; Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
12
|
Yang Z, Sun Y, Deng C, Dong X, Hao L. Comparative efficacy of robotic-assisted and freehand techniques for pedicle screw placement in spinal disorders: a meta-analysis and systematic review. J Robot Surg 2024; 18:121. [PMID: 38492043 DOI: 10.1007/s11701-024-01874-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
The efficacy and safety of robotic-assisted pedicle screw placement compared to traditional fluoroscopy-guided techniques are of great interest in the field of spinal surgery. This systematic review and meta-analysis aimed to compare the outcomes of these two methods in patients with spinal diseases. Following the PRISMA guidelines, we conducted a systematic search across PubMed, Embase, Web of Science, and Cochrane Library. We included randomized controlled trials comparing robotic-assisted and fluoroscopy-guided pedicle screw placement in patients with spinal diseases. Outcome measures included the accuracy of pedicle screw placement, postoperative complication rates, intraoperative radiation exposure time, and duration of surgery. Data were analyzed using Stata software. Our analysis included 12 studies. It revealed significantly higher accuracy in pedicle screw placement with robotic assistance (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 2.20-3.64, P < 0.01). Postoperative complication rates, intraoperative radiation exposure time, and duration of surgery were similar between the two techniques (OR = 0.72, 95% CI = 0.31 to 1.68, P = 0.56 for complication rates; weighted mean difference [WMD] = - 0.13, 95% CI = - 0.93 to 0.68, P = 0.86 for radiation exposure time; WMD = 0.30, 95% CI = - 0.06 to 0.66, P = 0.06 for duration of surgery). Robotic-assisted pedicle screw placement offers superior placement accuracy compared to fluoroscopy-guided techniques. Postoperative complication rates, intraoperative radiation exposure time, and duration of surgery were comparable for both methods. Future studies should explore the potential for fewer complications with the robotic-assisted approach as suggested by the lower point estimate.
Collapse
Affiliation(s)
- Zhanhua Yang
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China
| | - Yuhang Sun
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China
| | - Changcui Deng
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China.
| | - Xiuhui Dong
- Department of Dermatology, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China
| | - Liansheng Hao
- Department of Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, 1 Wenhua Road, Dongchangfu, Liaocheng, 252000, Shandong, China.
| |
Collapse
|
13
|
Lee YS, Cho DC, Kim KT. Navigation-Guided/Robot-Assisted Spinal Surgery: A Review Article. Neurospine 2024; 21:8-17. [PMID: 38569627 PMCID: PMC10992634 DOI: 10.14245/ns.2347184.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 04/05/2024] Open
Abstract
The development of minimally invasive spinal surgery utilizing navigation and robotics has significantly improved the feasibility, accuracy, and efficiency of this surgery. In particular, these methods provide improved accuracy of pedicle screw placement, reduced radiation exposure, and shortened learning curves for surgeons. However, research on the clinical outcomes and cost-effectiveness of navigation and robot-assisted spinal surgery is still in its infancy. Therefore, there is limited available evidence and this makes it difficult to draw definitive conclusions regarding the long-term benefits of these technologies. In this review article, we provide a summary of the current navigation and robotic spinal surgery systems. We concluded that despite the progress that has been made in recent years, and the clear advantages these methods can provide in terms of clinical outcomes and shortened learning curves, cost-effectiveness remains an issue. Therefore, future studies are required to consider training costs, variable initial expenses, maintenance and service fees, and operating costs of these advanced platforms so that they are feasible for implementation in standard clinical practice.
Collapse
Affiliation(s)
- Young-Seok Lee
- Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Dae-Chul Cho
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
14
|
Jung B, Han J, Shahsavarani S, Abbas AM, Echevarria AC, Carrier RE, Ngan A, Katz AD, Essig D, Verma R. Robotic-Assisted Versus Fluoroscopic-Guided Surgery on the Accuracy of Spine Pedicle Screw Placement: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54969. [PMID: 38410625 PMCID: PMC10896625 DOI: 10.7759/cureus.54969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 02/28/2024] Open
Abstract
Spinal fusion is a common method by which surgeons decrease instability and deformity of the spinal segment targeted. Pedicle screws are vital tools in fusion surgeries and advancements in technology have introduced several modalities of screw placement. Our objective was to evaluate the accuracy of pedicle screw placement in robot-assisted (RA) versus fluoroscopic-guided (FG) techniques. The PubMed and Cochrane Library databases were systematically reviewed from January 2007 through to August 8, 2022, to identify relevant studies. The accuracy of pedicle screw placement was determined using the Gertzbein-Robbins (GR) classification system. Facet joint violation (FJV), total case radiation dosage, total case radiation time, total operating room (OR) time, and total case blood loss were collected. Twenty-one articles fulfilled the inclusion criteria. Successful screw accuracy (GR Grade A or B) was found to be 1.02 (95% confidence interval: 1.01 - 1.04) times more likely with the RA technique. In defining accuracy solely based on the GR Grade A criteria, screws placed with RA were 1.10 (95% confidence interval: 1.06 - 1.15) times more likely to be accurate. There was no significant difference between the two techniques with respect to blood loss (Hedges' g: 1.16, 95% confidence interval: -0.75 to 3.06) or case radiation time (Hedges' g: -0.34, 95% CI: -1.22 to 0.53). FG techniques were associated with shorter operating room times (Hedges' g: -1.03, 95% confidence interval: -1.76 to -0.31), and higher case radiation dosage (Hedges' g: 1.61, 95% confidence interval: 1.11 to 2.10). This review suggests that RA may slightly increase pedicle screw accuracy and decrease per-case radiation dosage compared to FG techniques. However, total operating times for RA cases are greater than those for FG cases.
Collapse
Affiliation(s)
- Bongseok Jung
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
- Orthopedics, Donald and Barbara Zucker School of Medicine, Hempstead, USA
| | - Justin Han
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | | | - Anas M Abbas
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | | | | | - Alex Ngan
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | - Austen D Katz
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | - David Essig
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | - Rohit Verma
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| |
Collapse
|
15
|
Gamal A, Moschovas MC, Jaber AR, Saikali S, Perera R, Headley C, Patel E, Rogers T, Roche MW, Leveillee RJ, Albala D, Patel V. Clinical applications of robotic surgery platforms: a comprehensive review. J Robot Surg 2024; 18:29. [PMID: 38231279 DOI: 10.1007/s11701-023-01815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024]
Abstract
Robotic surgery has expanded globally across various medical specialties since its inception more than 20 years ago. Accompanying this expansion were significant technological improvements, providing tremendous benefits to patients and allowing the surgeon to perform with more precision and accuracy. This review lists some of the different types of platforms available for use in various clinical applications. We performed a literature review of PubMed and Web of Science databases in May 2023, searching for all available articles describing surgical robotic platforms from January 2000 (the year of the first approved surgical robot, da Vinci® System, by Intuitive Surgical) until May 1st, 2023. All retrieved robotic platforms were then divided according to their clinical application into four distinct groups: soft tissue robotic platforms, orthopedic robotic platforms, neurosurgery and spine platforms, and endoluminal robotic platforms. Robotic surgical technology has undergone a rapid expansion over the last few years. Currently, multiple robotic platforms with specialty-specific applications are entering the market. Many of the fields of surgery are now embracing robotic surgical technology. We review some of the most important systems in clinical practice at this time.
Collapse
Affiliation(s)
- Ahmed Gamal
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA.
| | - Marcio Covas Moschovas
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
- University of Central Florida (UCF), Orlando, FL, USA
| | - Abdel Rahman Jaber
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Shady Saikali
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Roshane Perera
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Chris Headley
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Ela Patel
- Stanford University, Palo Alto, CA, USA
| | - Travis Rogers
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Martin W Roche
- Department of Arthroplasty, Hospital for Special Surgery Florida, West Palm Beach, FL, USA
| | | | - David Albala
- Associated Medical Professionals, Urology, Syracuse, NY, USA
| | - Vipul Patel
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
- University of Central Florida (UCF), Orlando, FL, USA
| |
Collapse
|
16
|
Zhao J, Zhang Y, Fan M, Han X, Liu B, He D, Tian W. The positional consistency between guidewire and cannulated or solid screw in robot-assisted spinal internal fixation surgery. J Orthop Surg Res 2024; 18:708. [PMID: 38178197 PMCID: PMC10768200 DOI: 10.1186/s13018-023-04053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND This study aimed to investigate the positional consistency between the guidewire and the screw in spinal internal fixation surgery. METHODS This study involved 64 patients who underwent robot-assisted thoracic or lumbar pedicle screw fixation surgery. Guidewires were inserted with the assistance of the Tirobot. Either cannulated screws or solid screws were inserted. Guidewire and screw accuracy was measured using CT images based on the Gertzbein and Robbins scale. The positional consistency between guidewire and screw was evaluated based on the fused CT images, which could graphically and quantitatively demonstrate the consistency. The consistency was evaluated based on a grading system that considered the maximum distance and angulation between the centerline of the guidewire and the screw in the region of the pedicle. RESULTS A total of 322 screws were placed including 206 cannulated ones and 116 solid ones. Based on the Gertzbein and Robbins scale, 97.5% of the guidewires were grade A, and 94.1% of the screws were grade A. Based on our guidewire-screw consistency scale, 85% in cannulated group, and 69.8% in solid group, were grade A. Both solid and cannulated screws may alter trajectory compared to the guidewires. The positional accuracy and guidewire-screw consistency in the solid screw group is significantly worse than that in the cannulated screw group. The cortical bone of the pedicle has a positive guide effect on either solid or cannulated screws. CONCLUSION The pedicle screws may alter trajectory despite the guidance of the guidewires. Solid screws show worse positional accuracy and guidewire-screw consistency compared with cannulated screws. Trial registration The study was retrospectively registered and approved by our center's institutional review board.
Collapse
Affiliation(s)
- Jingwei Zhao
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.
| | - Yunxian Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Mingxing Fan
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoguang Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
17
|
Heard JC, Lee YA, D’Antonio ND, Narayanan R, Lambrechts MJ, Bodnar J, Purtill C, Pezzulo JD, Farronato D, Fitzgerald P, Canseco JA, Kaye ID, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. The impact of robotic assistance for lumbar fusion surgery on 90-day surgical outcomes and 1-year revisions. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:15-20. [PMID: 38644906 PMCID: PMC11029112 DOI: 10.4103/jcvjs.jcvjs_145_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 04/23/2024] Open
Abstract
Objectives To evaluate the (1) 90-day surgical outcomes and (2) 1-year revision rate of robotic versus nonrobotic lumbar fusion surgery. Methods Patients >18 years of age who underwent primary lumbar fusion surgery at our institution were identified and propensity-matched in a 1:1 fashion based on robotic assistance during surgery. Patient demographics, surgical characteristics, and surgical outcomes, including 90-day surgical complications and 1-year revisions, were collected. Multivariable regression analysis was performed. Significance was set to P < 0.05. Results Four hundred and fifteen patients were identified as having robotic lumbar fusion and were matched to a control group. Bivariant analysis revealed no significant difference in total 90-day surgical complications (P = 0.193) or 1-year revisions (P = 0.178). The operative duration was longer in robotic surgery (287 + 123 vs. 205 + 88.3, P ≤ 0.001). Multivariable analysis revealed that robotic fusion was not a significant predictor of 90-day surgical complications (odds ratio [OR] = 0.76 [0.32-1.67], P = 0.499) or 1-year revisions (OR = 0.58 [0.28-1.18], P = 0.142). Other variables identified as the positive predictors of 1-year revisions included levels fused (OR = 1.26 [1.08-1.48], P = 0.004) and current smokers (OR = 3.51 [1.46-8.15], P = 0.004). Conclusion Our study suggests that robotic-assisted and nonrobotic-assisted lumbar fusions are associated with a similar risk of 90-day surgical complications and 1-year revision rates; however, robotic surgery does increase time under anesthesia.
Collapse
Affiliation(s)
- Jeremy C. Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Yunsoo A. Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nicholas D. D’Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John Bodnar
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Caroline Purtill
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Joshua D. Pezzulo
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Dominic Farronato
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Pat Fitzgerald
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| |
Collapse
|
18
|
Li Y, Wei X, Liang Y, Song G. Robot-assisted versus fluoroscopy-guided pedicle screw fixation of thoracolumbar compression fractures. Medicine (Baltimore) 2023; 102:e36430. [PMID: 38050284 PMCID: PMC10695527 DOI: 10.1097/md.0000000000036430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
The aim of this study is to compare the clinical outcomes and accuracy of robot-assisted (RA) versus fluoroscopy-guided (FG) pedicle screw fixation of thoracolumbar compression fractures. We retrospectively enrolled 85 patients with surgically treated thoracolumbar compression fractures in our study (RA group, 45 patients; FG group, 40 patients). We analyzed the accuracy of pedicle screw placement by using the Gertzbein-Robbins classification, and calculated the one-time success rate (i.e., the rate of screws successfully inserted in the first attempt). We also evaluated volume of blood loss, operative time, visual analogue scale scores for pain, Cobb angle, and postoperative complications. The rates of grade A screw placement (96% vs 68.5%; P < .005), clinically acceptable screw placement (98.2% vs 86%; P < .005), and the one-time success rate (97.3% vs 82.5%; P < .005) were all significantly higher in the RA group than in the FG group. No differences were observed in sex, age, body mass index, volume of blood loss, operative time, visual analogue scale scores, Cobb angle, and postoperative complications between the 2 groups. Compared to FG surgery, RA surgery yielded greater accuracy and one-time success rates of pedicle screw fixation of thoracolumbar compression fractures, with comparable clinical outcomes.
Collapse
Affiliation(s)
- Yongjun Li
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xing Wei
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yonghui Liang
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Guangze Song
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| |
Collapse
|
19
|
Wang J, Miao J, Zhan Y, Duan Y, Wang Y, Hao D, Wang B. Spine Surgical Robotics: Current Status and Recent Clinical Applications. Neurospine 2023; 20:1256-1271. [PMID: 38171293 PMCID: PMC10762389 DOI: 10.14245/ns.2346610.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 01/05/2024] Open
Abstract
With the development of artificial intelligence and the further deepening of medical-engineering integration, spine surgical robot-assisted (RA) technique has made significant progress and its applicability in clinical practice is constantly expanding in recent years. In this review, we have systematically summarized the majority of literature related to spine surgical robots in the past decade, and not only classified robots accordingly, but also summarized the latest research progress in RA technique for screw placement such as cervical, thoracic, and lumbar pedicle screws, cortical bone trajectory screws, cervical lateral mass screws, and S2 sacroiliac screws; guiding targeted puncture and placement of endoscope via the intervertebral foramen; complete resection of spinal tumor tissue; and decompressive laminectomy. In addition, this report also provides a detailed evaluation of RA technique's advantages and disadvantages, and clarifies the accuracy, safety, and practicality of RA technique. We consider that this review can help clinical physicians further understand and familiarize the current clinical application status of spine surgical robots, thereby promoting the continuous improvement and popularization of RA technique, and ultimately benefiting numerous patients.
Collapse
Affiliation(s)
- Jiangtao Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Medical School of Yan’an University, Yan’an, China
| | - Junxian Miao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Shaanxi University of Chinese Medicine, Xi’an, China
| | - Yi Zhan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Shaanxi University of Chinese Medicine, Xi’an, China
| | - Yongchao Duan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Department of Intraoperative Imaging, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yuanshun Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Department of Orthopedics, The Third People’s Hospital of Xining, Qinghai, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Biao Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| |
Collapse
|
20
|
Lin T, Xie Q, Peng T, Zhao X, Chen D. The role of robotic surgery in neurological cases: A systematic review on brain and spine applications. Heliyon 2023; 9:e22523. [PMID: 38046149 PMCID: PMC10686875 DOI: 10.1016/j.heliyon.2023.e22523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/20/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023] Open
Abstract
The application of robotic surgery technologies in neurological surgeries resulted in some advantages compared to traditional surgeries, including higher accuracy and dexterity enhancement. Its success in various surgical fields, especially in urology, cardiology, and gynecology surgeries was reported in previous studies, and similar advantages in neurological surgeries are expected. Surgeries in the central nervous system with the pathology of millimeters through small working channels around vital tissue need especially high precision. Applying robotic surgery is therefore an interesting dilemma for these situations. This article reviews various studies published on the application of brain and spine robotic surgery and discusses the current application of robotic technology in neurological cases.
Collapse
Affiliation(s)
- Tong Lin
- Neurosurgery, Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-Sen University, 535000, Nanning, China
| | - Qinghai Xie
- Neurosurgery, Qinzhou First People's Hospital, Qinzhou City, 535000, China
| | - Tao Peng
- Neurosurgery, Qinzhou First People's Hospital, Qinzhou City, 535000, China
| | - Xianxiao Zhao
- Neurosurgery, Qinzhou First People's Hospital, Qinzhou City, 535000, China
| | - Dongliang Chen
- Neurosurgery, Qinzhou First People's Hospital, Qinzhou City, 535000, China
| |
Collapse
|
21
|
Suri I, Suri M, Hu J, Dedhia SK, Yaeger K. Case Volume Justification of 3D-Navigated Spinal Procedures: A Cost-Benefit Analysis. J Med Syst 2023; 47:114. [PMID: 37938464 DOI: 10.1007/s10916-023-02000-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/28/2023] [Indexed: 11/09/2023]
Abstract
3D image-guidance platforms have transformed spinal surgery by enhancing visualization, increasing precision, and improving patient outcomes. However, with high procurement, operational, and maintenance costs relative to the standard of care, the benefits of acquiring these platforms must be thoroughly assessed. This study aims to develop a model that weighs the cost of a typical 3D navigation platform against its clinical benefits to determine the facility case volume required to justify its purchase. Using Medtronic's StealthStation and O-Arm as a market example, we calculated the break-even case volume by dividing the cost of the platform by the difference in gross margins between 3D navigation and the standard of care. Total gross margins earned from first-time and revision surgeries were calculated based on each payer's reimbursement rate and covered case volume, as well as each technology's revision rate. Values reported in literature and by Centers for Medicare and Medicaid Services databases were plugged into the model to calculate variables. At a 0% reimbursement rate from private payers for revision surgeries, an annual case volume of 158 spinal surgeries would be required to justify the per-year 3D navigation cost; at 100% private payer reimbursement, 352 surgeries would be required. Given these volumes, 61% of all US inpatient facilities cannot justify 3D navigation at 0% reimbursement, and 86% cannot justify it at 100% reimbursement. Accordingly, greater pricing flexibility, such as per-procedure models, is required for 3D navigation systems to standardize clinical outcomes across medical centers.
Collapse
Affiliation(s)
- Ikaasa Suri
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA.
- Illuminant Surgical, Inc., Cambridge, MA, USA.
| | - Mehr Suri
- Stern School of Business, New York University, New York, NY, USA
| | - James Hu
- Illuminant Surgical, Inc., Cambridge, MA, USA
| | - Siddarth Ketan Dedhia
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kurt Yaeger
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
22
|
Zawar A, Chhabra HS, Mundra A, Sharma S, Kalidindi KKV. Robotics and navigation in spine surgery: A narrative review. J Orthop 2023; 44:36-46. [PMID: 37664556 PMCID: PMC10470401 DOI: 10.1016/j.jor.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction In recent decades, there has been a rising trend of spinal surgical interventional techniques, especially Minimally Invasive Spine Surgery (MIS), to improve the quality of life in an effective and safe manner. However, MIS techniques tend to be difficult to adapt and are associated with an increased risk of radiation exposure. This led to the development of 'computer-assisted surgery' in 1983, which integrated CT images into spinal procedures evolving into the present day robotic-assisted spine surgery. The authors aim to review the development of spine surgeries and provide an overview of the benefits offered. It includes all the comparative studies available to date. Methods The manuscript has been prepared as per "SANRA-a scale for the quality assessment of narrative review articles". The authors searched Pubmed, Embase, and Scopus using the terms "(((((Robotics) OR (Navigation)) OR (computer assisted)) OR (3D navigation)) OR (Freehand)) OR (O-Arm)) AND (spine surgery)" and 68 articles were included for analysis excluding review articles, meta-analyses, or systematic literature. Results The authors noted that 49 out of 68 studies showed increased precision of pedicle screw insertion, 10 out of 19 studies show decreased radiation exposure, 13 studies noted decreased operative time, 4 out of 8 studies showed reduced hospital stay and significant reduction in rates of infections, neurological deficits, the need for revision surgeries, and rates of radiological ASD, with computer-assisted techniques. Conclusion Computer-assisted surgeries have better accuracy of pedicle screw insertion, decreased blood loss and operative time, reduced radiation exposure, improved functional outcomes, and lesser complications.
Collapse
Affiliation(s)
- Amogh Zawar
- Rajiv Gandhi Medical College and CSMH, Thane, Maharashtra. 400605, India
| | | | - Anuj Mundra
- Sri Balaji Action Medical Institute, A4 Block, Paschim Vihar, New Delhi, 110063, India
| | - Sachin Sharma
- Sri Balaji Action Medical Institute, A4 Block, Paschim Vihar, New Delhi, 110063, India
| | | |
Collapse
|
23
|
Katz AD, Galina J, Song J, Hasan S, Perfetti D, Virk S, Silber J, Essig D. Impact of Navigation on 30-Day Outcomes for Adult Spinal Deformity Surgery. Global Spine J 2023; 13:1728-1736. [PMID: 34569338 PMCID: PMC10556894 DOI: 10.1177/21925682211047551] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY DESIGN Retrospective database study. OBJECTIVE Navigation has been increasingly used to treat degenerative disease, with positive radiographic and clinical outcomes and fewer adverse events and reoperations, despite increased operative time. However, short-term analysis on treating adult spinal deformity (ASD) surgery with navigation is limited, particularly using large nationally represented cohorts. This is the first large-scale database study to compare 30-day readmission, reoperation, morbidity, and value-per-operative time for navigated and conventional ASD surgery. METHODS Adults were identified in the National Surgical Quality Improvement Program (NSQIP) database. Multivariate regression was used to compare outcomes between navigated and conventional surgery and to control for predictors and baseline differences. RESULTS 3190 ASD patients were included. Navigated and conventional patients were similar. Navigated cases had greater operative time (405 vs 320 min) and mean RVUs per case (81.3 vs 69.7), and had more supplementary pelvic fixations (26.1 vs 13.4%) and osteotomies (50.3 vs 27.7%) (P <.001).In univariate analysis, navigation had greater reoperation (9.9 vs 5.2%, P = .011), morbidity (57.8 vs 46.8%, P = .007), and transfusion (52.2 vs 41.8%, P = .010) rates. Readmission was similar (11.9 vs 8.4%). In multivariate analysis, navigation predicted reoperation (OR = 1.792, P = .048), but no longer predicted morbidity or transfusion. Most reoperations were infectious and hardware-related. CONCLUSIONS Despite controlling for patient-related and procedural factors, navigation independently predicted a 79% increased odds of reoperation but did not predict morbidity or transfusion. Readmission was similar between groups. This is explained, in part, by greater operative time and transfusion, which are risk factors for infection. Reoperation most frequently occurred for wound- and hardware-related reasons, suggesting navigation carries an increased risk of infectious-related events beyond increased operative time.
Collapse
Affiliation(s)
- Austen D. Katz
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Jesse Galina
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Junho Song
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Sayyida Hasan
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Dean Perfetti
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Sohrab Virk
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - Jeff Silber
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| | - David Essig
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA
| |
Collapse
|
24
|
Wang R, Bai H, Xia G, Zhou J, Dai Y, Xue Y. Identification of milling status based on vibration signals using artificial intelligence in robot-assisted cervical laminectomy. Eur J Med Res 2023; 28:203. [PMID: 37381061 DOI: 10.1186/s40001-023-01154-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/03/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND With advances in science and technology, the application of artificial intelligence in medicine has significantly progressed. The purpose of this study is to explore whether the k-nearest neighbors (KNN) machine learning method can identify three milling states based on vibration signals: cancellous bone (CCB), ventral cortical bone (VCB), and penetration (PT) in robot-assisted cervical laminectomy. METHODS Cervical laminectomies were performed on the cervical segments of eight pigs using a robot. First, the bilateral dorsal cortical bone and part of the CCB were milled with a 5 mm blade and then the bilateral laminae were milled to penetration with a 2 mm blade. During the milling process using the 2 mm blade, the vibration signals were collected by the acceleration sensor, and the harmonic components were extracted using fast Fourier transform. The feature vectors were constructed with vibration signal amplitudes of 0.5, 1.0, and 1.5 kHz and the KNN was then trained by the features vector to predict the milling states. RESULTS The amplitudes of the vibration signals between VCB and PT were statistically different at 0.5, 1.0, and 1.5 kHz (P < 0.05), and the amplitudes of the vibration signals between CCB and VCB were significantly different at 0.5 and 1.5 kHz (P < 0.05). The KNN recognition success rates for the CCB, VCB, and PT were 92%, 98%, and 100%, respectively. A total of 6% and 2% of the CCB cases were identified as VCB and PT, respectively; 2% of VCB cases were identified as PT. CONCLUSIONS The KNN can distinguish different milling states of a high-speed bur in robot-assisted cervical laminectomy based on vibration signals. This method is feasible for improving the safety of posterior cervical decompression surgery.
Collapse
Affiliation(s)
- Rui Wang
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - He Bai
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Guangming Xia
- Tianjin Key Laboratory of Intelligent Robotics, Institute of Robotics and Automatic Information System, College of Artificial Intelligence, Nankai University, 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Jiaming Zhou
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yu Dai
- Tianjin Key Laboratory of Intelligent Robotics, Institute of Robotics and Automatic Information System, College of Artificial Intelligence, Nankai University, 94 Weijin Road, Nankai District, Tianjin, 300071, China.
| | - Yuan Xue
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| |
Collapse
|
25
|
Kanaly CW, Backes DM, Toossi N, Bucklen B. A Retrospective Analysis of Pedicle Screw Placement Accuracy Using the ExcelsiusGPS Robotic Guidance System: Case Series. Oper Neurosurg (Hagerstown) 2023; 24:242-247. [PMID: 36454079 DOI: 10.1227/ons.0000000000000498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Robotic guidance has become widespread in spine surgery. Although the intent is improved screw placement, further system-specific data are required to substantiate this intention for pedicle screws in spinal stabilization constructs. OBJECTIVE To determine the accuracy of pedicle screws placed with the aid of a robot in a cohort of patients immediately after the adoption of the robot-assisted surgery technique. METHODS A retrospective, Institutional Review Board-approved study was performed on the first 100 patients at a single facility, who had undergone spinal surgeries with the use of robotic techniques. Pedicle screw accuracy was graded using the Gertzbein-Robbins Scale based on pedicle wall breach, with grade A representing 0 mm breach and successive grades increasing breach thresholds by 2 mm increments. Preoperative and postoperative computed tomography scans were also used to assess offsets between the objective plan and true screw placements. RESULTS A total of 326 screws were analyzed among 72 patients with sufficient imaging data. Ages ranged from 21 to 84 years. The total accuracy rate based on the Gertzbein-Robbins Scale was 97.5%, and the rate for each grade is as follows: A, 82%; B, 15.5%; C, 1.5%; D, 1%; and E, 0. The average tip offset was 1.9 mm, the average tail offset was 2.0 mm, and the average angular offset was 2.6°. CONCLUSION Robotic-assisted surgery allowed for accurate implantation of pedicle screws on immediate adoption of this technique. There were no complications attributable to the robotic technique, and no hardware revisions were required.
Collapse
Affiliation(s)
- Charles W Kanaly
- Steward St. Anne's Hospital, Fall River, Massachusetts, USA
- Neurosurgery Center of Southern New England, PC, Fall River, Massachusetts, USA
| | - Danielle M Backes
- Neurosurgery Center of Southern New England, PC, Fall River, Massachusetts, USA
| | - Nader Toossi
- Musculoskeletal and Education Research Center, Clinical Research Department, Audubon, Pennsylvania, USA
| | - Brandon Bucklen
- Musculoskeletal and Education Research Center, Clinical Research Department, Audubon, Pennsylvania, USA
| |
Collapse
|
26
|
Hu XB, Gu C, Chen AQ, Ying GY, Shen F, Zhu YJ. Percutaneous Full Endoscopic Management of Spinal Foraminal Schwannomas: Case Series. Oper Neurosurg (Hagerstown) 2023; 24:483-491. [PMID: 36735518 DOI: 10.1227/ons.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Schwannoma, a benign peripheral nerve sheath tumor, is perhaps only secondary to degenerative pathology as the most common lesion at neural foramen. The surgical dilemma here is either risking nerve injury because of inadequate exposure or the need for internal fixation because of facet joint sacrifice. OBJECTIVE To evaluate the feasibility and safety of management of foraminal schwannomas by percutaneous full-endoscopic technique. METHODS A single-center retrospective review was conducted on patients who underwent full-endoscopic resection of neural foraminal schwannomas. Tumors were grouped into either medial type or lateral type based on relevant location to the neural foramen, and respective surgical approaches were adopted. Data including preoperative neurological status, tumor size, surgery time, the extension of resection, and clinical outcomes were collected. The learning curve was plotted as surgical time/tumor size against case number. RESULTS A total of 25 patients were treated between May 2015 and March 2022. Gross total resection was achieved in 24 patients, and near-total resection in 1 case, with 1 patient experienced transient voiding difficulty. No tumor recurrence or spinal instability was detected in the short-term follow-up (median follow-up 22 months, range 3 months-6 years). Surgical efficiency improved with the number of cases operated on and remained stable after the initial 10 cases. CONCLUSION Percutaneous full-endoscopic technique is a safe and minimally invasive technique for the resection of foraminal schwannomas.
Collapse
Affiliation(s)
- Xin-Ben Hu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chi Gu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ai-Qin Chen
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Guang-Yu Ying
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fang Shen
- Department of Surgery, Box Hill Hospital, Eastern Health, Box Hill, Australia
| | - Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
27
|
Schwendner M, Meyer B, Krieg SM. [Robot-assisted pedicle screw placement]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:37-42. [PMID: 36459194 DOI: 10.1007/s00064-022-00792-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/29/2022] [Accepted: 07/10/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Pedicle screw-based posterior instrumentation of the spine. INDICATIONS Instability of the spine due to trauma, infection, degenerative spinal disease or tumor. CONTRAINDICATIONS None. SURGICAL TECHNIQUE Robot-assisted navigated pedicle screw placement. POSTOPERATIVE MANAGEMENT Early functional mobilization starting on the first postoperative day. RESULTS A study by Lee et al. analyzed the clinical application of the system Mazor X Stealth Edition (Medtronic Navigation, Louisville, CO, USA; Medtronic Spine, Memphis, TN, USA) in 186 cases with a total of 1445 pedicle screws [1]. Correct screw positioning was achieved in 1432 pedicle screws (99.1%); six pedicle screws (0.4%) were revised intraoperatively. The mean duration of pedicle screw placement was 6.1 ± 2.3 min. Pojskić et al. published a case series regarding the application of the system Cirq (Brainlab, Munich, Germany) in 13 cases with a total number of 70 pedicle screws implanted [2]. Intraoperative imaging showed screw positioning according to the Gertzbein Robbins classification (GR) category A in 65 screws (92.9%) and GR B in one screw (1.4%). Screw positioning GR D with intraoperative revision was reported in two screws (2.9%). Mean duration of pedicle screw placement was 08:27 ± 06:54 min.
Collapse
Affiliation(s)
- Maximilian Schwendner
- Klinik und Poliklinik für Neurochirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Bernhard Meyer
- Klinik und Poliklinik für Neurochirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Sandro M Krieg
- Klinik und Poliklinik für Neurochirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| |
Collapse
|
28
|
Charles YP, Lamas V, Ntilikina Y. Artificial intelligence and treatment algorithms in spine surgery. Orthop Traumatol Surg Res 2023; 109:103456. [PMID: 36302452 DOI: 10.1016/j.otsr.2022.103456] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/12/2022] [Accepted: 05/25/2022] [Indexed: 12/24/2022]
Abstract
Artificial intelligence (AI) is a set of theories and techniques in which machines are used to simulate human intelligence with complex computer programs. The various machine learning (ML) methods are a subtype of AI. They originate from computer science and use algorithms established from analyzing a database to accomplish certain tasks. Among these methods are decision trees or random forests, support vector machines along with artificial neural networks. Convolutive neural networks were inspired from the visual cortex; they process combinations of information used in image or voice recognition. Deep learning (DL) groups together a set of ML methods and is useful for modeling complex relationships with a high degree of abstraction by using multiple layers of artificial neurons. ML techniques have a growing role in spine surgery. The main applications are the segmentation of intraoperative images for surgical navigation or robotics used for pedicle screw placement, the interpretation of images of intervertebral discs or full spine radiographs, which can be automated using ML algorithms. ML techniques can also be used as aids for surgical decision-making in complex fields, such as preoperative evaluation of adult spinal deformity. ML algorithms "learn" from large clinical databases. They make it possible to establish the intraoperative risk level and make a prognosis on how the postoperative functional scores will change over time as a function of the patient profile. These applications open a new path relative to standard statistical analyses. They make it possible to explore more complex relationships with multiple indirect interactions. In the future, AI algorithms could have a greater role in clinical research, evaluating clinical and surgical practices, and conducting health economics analyses.
Collapse
Affiliation(s)
- Yann Philippe Charles
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | - Vincent Lamas
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Yves Ntilikina
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| |
Collapse
|
29
|
Lopez IB, Benzakour A, Mavrogenis A, Benzakour T, Ahmad A, Lemée JM. Robotics in spine surgery: systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2023; 47:447-456. [PMID: 35849162 DOI: 10.1007/s00264-022-05508-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Over 4.83 million spine surgery procedures are performed annually around the world. With the considerable caseload and the precision needed to achieve optimal spinal instrumentation, technical progress has helped to improve the technique's safety and accuracy with the development of peri-operative assistance tools. Contrary to other surgical applications already part of the standard of care, the development of robotics in spine surgery is still a novelty and is not widely available nor used. Robotics, especially when coupled with other guidance modalities such as navigation, seems to be a promising tool in our quest for accuracy, improving patient outcomes and reducing surgical complications. Robotics in spine surgery may also be for the surgeon a way to progress in terms of ergonomics, but also to respond to a growing concern among surgical teams to reduce radiation exposure. METHOD We present in this recent systematic review of the literature realized according to the PRISMA guidelines the place of robotics in spine surgery, reviewing the comparison to standard techniques, the current and future indications, the learning curve, the impact on radiation exposure, and the cost-effectiveness. RESULTS Seventy-six relevant original studies were identified and analyzed for the review. CONCLUSION Robotics has proved to be a safe help for spine surgery, both for the patient with a decrease of operating time and increase in pedicular screw accuracy, and for the surgical team with a decrease of radiation exposure. Medico-economic studies demonstrated that despite a high buying cost, the purchase of a robot dedicated for spine surgery is cost-effective resulting in lesser revision, lower infection, reduced length of stay, and shorter surgical procedure.
Collapse
Affiliation(s)
- Ignacio Barrio Lopez
- Department of Neurosurgery, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 09, France
| | - Ahmed Benzakour
- Centre Orléanais du Dos, Pôle Santé Oréliance, Saran, France
| | - Andreas Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Jean-Michel Lemée
- Department of Neurosurgery, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 09, France. .,INSERM CRCI2NA Team 5, GLIAD, Angers, France.
| |
Collapse
|
30
|
Gabrovsky N, Ilkov P, Laleva M. Cirq® robotic assistance for thoracolumbar pedicle screw placement - feasibility, accuracy, and safety. BRAIN & SPINE 2023; 3:101717. [PMID: 37383441 PMCID: PMC10293294 DOI: 10.1016/j.bas.2023.101717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 06/30/2023]
Abstract
Introduction New technologies providing higher degree of precision, less risk for damage and less harmful exposure to radiation are necessary for correct transpedicular screw trajectory, but their efficacy should be evaluated. Research Question Evaluate the feasibility, accuracy and safety of Brainlab Cirq® navigated robotic arm assistance for pedicle screw placement in comparison to fluoroscopic guidance. Material and Methods Group I "Cirq® robotic-assisted group" - 97 screws in 21 prospectively analyzed patients. Group II "Fluoroscopy-guided group" - 98 screws in 16 consecutive patients analyzed retrospectively. Comparative evaluations included screw accuracy on Gertzbein-Robbins's scale and fluoroscopy time. Time per screw and subjective mental workload (MWL) measured with the raw NASA task load index tool were assessed for Group I. Results 195 screws were evaluated. Group I: 93 screws grade A (95.88%); 4 grade B (4.12%). In Group II, 87 screws grade A (88.78%); 9 grade B (9.18%); 1 grade C (1.02%); 1 grade D (1.02%). While the screws placed using the Cirq® system were more accurate overall, there was no statistical significance between the two groups, p=0.3714. There was no significant difference in operation length or radiation exposure between the two groups, however with the Cirq® system the radiation exposure for the surgeon was limited. Reduction in time per screw (p<0.0001) and in the MWL (p=0.0024) correlated with the surgeon's experience with Cirq®. Discussion and Conclusion The initial experience suggests that navigated, passive robotic arm assistance is feasible, at least as accurate as fluoroscopic guidance, and safe for pedicle screw placement.
Collapse
Affiliation(s)
- Nikolay Gabrovsky
- Corresponding author. Department of Neurosurgery, University Hospital “Pirogov”, 1606, Sofia, Bulgaria.
| | | | | |
Collapse
|
31
|
Zimmermann F, Franke J, Vetter SY, Grützner PA. [Computer-assisted procedures in orthopedics and trauma surgery-Where do we stand?]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:292-298. [PMID: 36600030 DOI: 10.1007/s00104-022-01789-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/06/2023]
Abstract
Computer-assisted procedures are becoming increasingly more relevant in orthopedics and trauma surgery. The data situation on these systems has improved in recent years but still has a low level of evidence. In particular, data on short-term or medium-term results on the use of these procedures are currently available. These could show that improved precision and reproducibility of the surgical procedures can be achieved by the use of computer-assisted procedures. Nevertheless, there is still no recommendation in the current guidelines for routine use.
Collapse
Affiliation(s)
- Felix Zimmermann
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland.
| | - Jochen Franke
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Sven Y Vetter
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Paul A Grützner
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| |
Collapse
|
32
|
Gajjar AA, Huy Dinh Le A, Swaroop Lavadi R, Boddeti U, Barpujari A, Agarwal N. Evolution of Robotics in Neurosurgery: A Historical Perspective. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
|
33
|
Lanza C, Carriero S, Buijs EFM, Mortellaro S, Pizzi C, Sciacqua LV, Biondetti P, Angileri SA, Ianniello AA, Ierardi AM, Carrafiello G. Robotics in Interventional Radiology: Review of Current and Future Applications. Technol Cancer Res Treat 2023; 22:15330338231152084. [PMID: 37113061 PMCID: PMC10150437 DOI: 10.1177/15330338231152084] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
This review is a brief overview of the current status and the potential role of robotics in interventional radiology. Literature published in the last decades, with an emphasis on the last 5 years, was reviewed and the technical developments in robotics and navigational systems using CT-, MR- and US-image guidance were analyzed. Potential benefits and disadvantages of their current and future use were evaluated. The role of fusion imaging modalities and artificial intelligence was analyzed in both percutaneous and endovascular procedures. A few hundred articles describing results of single or several systems were included in our analysis.
Collapse
Affiliation(s)
- Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | | | - Sveva Mortellaro
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Caterina Pizzi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | | | - Pierpaolo Biondetti
- Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | | | | | | | - Gianpaolo Carrafiello
- Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
34
|
Gabrovsky N, Ilkov P, Laleva M. Cirq Robotic Assistance for Thoracolumbar Pedicle Screw Placement: Overcoming the Disadvantages of Minimally Invasive Spine Surgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:389-392. [PMID: 38153498 DOI: 10.1007/978-3-031-36084-8_59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Various minimally invasive spine surgery (MISS) techniques have been developed with the goal of reducing approach-related soft-tissue trauma and its associated complications. However, there is still a debate on some of the potential drawbacks of MISS techniques, such as their longer operating times and increased intraoperative radiation. A solution to these disadvantages could be the implementation of new technologies, such as computer-assisted navigation (CAN) and surgical robotics. We compare the standard fluoroscopy MISS technique with our experience with time per screw and X-ray exposure for pedicle screw placement using the Brainlab Cirq passive robotic arm assistance coupled with the Brainlab Curve navigation system. METHODS In the Cirq robot-assisted group (Group I), 109 screws were placed in 24 prospectively analyzed patients. In the fluoroscopy-guided group, 108 screws inserted into 20 consecutive patients were analyzed retrospectively (Group II). The duration of surgery, the time to place one screw, the X-ray exposition, and the pedicle screw accuracy for each patient were recorded and reviewed. RESULTS In total, 217 screws were analyzed. The treated levels ranged from T10 to S1. In Group I, 104 screws were grade A (95.4%) and five were grade B (4.6%). In Group II, 96 screws were grade A (88.89%); ten were grade B (9.26%); one was grade C (0.93%), and one was grade D (0.93%). While the screws placed by using the Cirq system were more accurate overall, there was no statistical significance when the two groups were compared, p = 0.3724. There was no significant difference in radiation exposure between the two groups, p = 0.5482; however the radiation exposure for the surgeon was very limited with the Cirq system. There was a significant reduction in the operation length (p = 0.0183) and the time per screw (p < 0.0001) for Group I. CONCLUSIONS The CAN systems and emerging robotic platforms have the potential to diminish the main disadvantages of MISS techniques-longer operation times and X-ray exposure, at least for the surgical team.
Collapse
Affiliation(s)
- Nikolay Gabrovsky
- Department of Neurosurgery, University Hospital "Pirogov", Sofia, Bulgaria
| | - Petar Ilkov
- Department of Neurosurgery, University Hospital "Pirogov", Sofia, Bulgaria
| | - Maria Laleva
- Department of Neurosurgery, University Hospital "Pirogov", Sofia, Bulgaria
| |
Collapse
|
35
|
Beyer RS, Nguyen A, Brown NJ, Gendreau JL, Hatter MJ, Pooladzandi O, Pham MH. Spinal robotics in cervical spine surgery: a systematic review with key concepts and technical considerations. J Neurosurg Spine 2023; 38:66-74. [PMID: 36087333 DOI: 10.3171/2022.7.spine22473] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/06/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Spinal robotics for thoracolumbar procedures, predominantly employed for the insertion of pedicle screws, is currently an emerging topic in the literature. The use of robotics in instrumentation of the cervical spine has not been broadly explored. In this review, the authors aimed to coherently synthesize the existing literature of intraoperative robotic use in the cervical spine and explore considerations for future directions and developments in cervical spinal robotics. METHODS A literature search in the Web of Science, Scopus, and PubMed databases was performed for the purpose of retrieving all articles reporting on cervical spine surgery with the use of robotics. For the purposes of this study, randomized controlled trials, nonrandomized controlled trials, retrospective case series, and individual case reports were included. The Newcastle-Ottawa Scale was utilized to assess risk of bias of the studies included in the review. To present and synthesize results, data were extracted from the included articles and analyzed using the PyMARE library for effect-size meta-analysis. RESULTS On careful review, 6 articles published between 2016 and 2022 met the inclusion/exclusion criteria, including 1 randomized controlled trial, 1 nonrandomized controlled trial, 2 case series, and 2 case reports. These studies featured a total of 110 patients meeting the inclusion criteria (mean age 53.9 years, range 29-77 years; 64.5% males). A total of 482 cervical screws were placed with the use of a surgical robot, which yielded an average screw deviation of 0.95 mm. Cervical pedicle screws were the primary screw type used, at a rate of 78.6%. According to the Gertzbein-Robbins classification, 97.7% of screws in this review achieved a clinically acceptable grade. The average duration of surgery, blood loss, and postoperative length of stay were all decreased in minimally invasive robotic surgery relative to open procedures. Only 1 (0.9%) postoperative complication was reported, which was a surgical site infection, and the mean length of follow-up was 2.7 months. No mortality was reported. CONCLUSIONS Robot-assisted cervical screw placement is associated with acceptable rates of clinical grading, operative time, blood loss, and postoperative complications-all of which are equal to or improved relative to the metrics seen in the conventional use of fluoroscopy or computer-assisted navigation for cervical screw placement.
Collapse
Affiliation(s)
- Ryan S Beyer
- 1Department of Neurological Surgery, University of California, Irvine, Orange
| | - Andrew Nguyen
- 2Department of Neurosurgery, UC San Diego School of Medicine, San Diego
| | - Nolan J Brown
- 1Department of Neurological Surgery, University of California, Irvine, Orange
| | - Julian L Gendreau
- 4Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland
| | - Matthew J Hatter
- 1Department of Neurological Surgery, University of California, Irvine, Orange
| | - Omead Pooladzandi
- 3Department of Electrical and Computer Engineering, University of California, Los Angeles, California; and
| | - Martin H Pham
- 2Department of Neurosurgery, UC San Diego School of Medicine, San Diego
| |
Collapse
|
36
|
Mualem W, Onyedimma C, Ghaith AK, Durrani S, Jarrah R, Singh R, Zamanian C, Nathani KR, Freedman BA, Bydon M. R2 advances in robotic-assisted spine surgery: comparative analysis of options, future directions, and bibliometric analysis of the literature. Neurosurg Rev 2022; 46:18. [PMID: 36515789 DOI: 10.1007/s10143-022-01916-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Spine surgery has undergone rapid advancements over the past several decades with the emergence of robotic and minimally invasive surgery (MIS). While conventional MIS spine surgery has had relative success, its complication profile has warranted continued efforts to improve clinical outcomes. We discuss the functional, clinical, and financial aspects of four robotic options for spinal pathologies, namely ROSA, Mazor X, Da Vinci, and ExcelsiusGPS, and conduct a bibliometric analysis to better understand current trends and applications of these robots as the field of robotic spine surgery continues to grow. An extensive search of English-language published literature on robotic-assisted spinal surgery was performed in Elsevier's Scopus database. A bibliometric analysis was then performed on the top 100 most cited papers. The search yielded articles regarding robotic-assisted spine surgery application, limitations, and functional outcomes secondary to spine pathology. Accuracy analyses of 1733 screw placements were reviewed. The top 100 papers were published between 1992 and 2020, with a significant increase from 2015 onwards. The top publishing institution was John Hopkins University (n = 8). The top contributing author was Dr. Isador H. Lieberman (n = 6). The USA (n = 34) had the most articles on robotic spinal surgery, followed by Germany (n = 12). This review examines robotic applications in spine surgery, including four available options: ROSA, Mazor X, Da Vinci, and ExcelsiusGPS. Publication output over time, surgical outcomes, screw accuracy, and cost-effectiveness of these technologies have been investigated here. Certain robots have functional, clinical, and financial differences worth noting. Given the dearth of existing literature reporting postoperative complications and long-term comparative outcomes, there is a clear need for further studies on this matter.
Collapse
Affiliation(s)
- William Mualem
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Chiduziem Onyedimma
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Sulaman Durrani
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Ryan Jarrah
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Rohin Singh
- Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
- Department of Neurologic Surgery, Mayo Clinic, Scottsdale, AZ, USA
| | - Cameron Zamanian
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Karim Rizwan Nathani
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
- Department of Neurologic Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
37
|
Chang J, Yu L, Li Q, Wang B, Yang L, Cheng M, Wang F, Zhang L, Chen L, Li K, Liang L, Zhou W, Cai W, Ren Y, Hu Z, Huang Z, Sui T, Fan J, Wang J, Li B, Cao X, Yin G. Development and Clinical Trial of a New Orthopedic Surgical Robot for Positioning and Navigation. J Clin Med 2022; 11:jcm11237091. [PMID: 36498666 PMCID: PMC9738984 DOI: 10.3390/jcm11237091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
Abstract
Robot-assisted orthopedic surgery has great application prospects, and the accuracy of the robot is the key to its overall performance. The aim of this study was to develop a new orthopedic surgical robot to assist in spinal surgeries and to compare its feasibility and accuracy with the existing orthopedic robot. A new type of high-precision orthopedic surgical robot (Tuoshou) was developed. A multicenter, randomized controlled trial was carried out to compare the Tuoshou with the TiRobot (TINAVI Medical Technologies Co., Ltd., Beijing) to evaluate the accuracy and safety of their navigation and positioning. A total of 112 patients were randomized, and 108 patients completed the study. The position deviation of the Kirschner wire placement in the Tuoshou group was smaller than that in the TiRobot group (p = 0.014). The Tuoshou group was better than the TiRobot group in terms of the pedicle screw insertion accuracy (p = 0.016) and entry point deviation (p < 0.001). No differences were observed in endpoint deviation (p = 0.170), axial deviation (p = 0.170), sagittal deviation (p = 0.324), and spatial deviation (p = 0.299). There was no difference in security indicators. The new orthopedic surgical robot was highly accurate and optimized for clinical practice, making it suitable for clinical application.
Collapse
Affiliation(s)
- Jie Chang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Lipeng Yu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qingqing Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Boyao Wang
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Lei Yang
- Department of Orthopedics, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou 225300, China
| | - Min Cheng
- Nanjing Tuodao Medical Technology Co., Ltd., Nanjing 210012, China
| | - Feng Wang
- Nanjing Tuodao Medical Technology Co., Ltd., Nanjing 210012, China
| | - Long Zhang
- Nanjing Tuodao Medical Technology Co., Ltd., Nanjing 210012, China
| | - Lei Chen
- Nanjing Tuodao Medical Technology Co., Ltd., Nanjing 210012, China
| | - Kun Li
- Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liang Liang
- Guizhou Provincial People’s Hospital, Guiyang 550002, China
| | - Wei Zhou
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Weihua Cai
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yongxin Ren
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhiyi Hu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhenfei Huang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Tao Sui
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jin Fan
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Junwen Wang
- Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Correspondence: (J.W.); (B.L.); (X.C.); (G.Y.)
| | - Bo Li
- Guizhou Provincial People’s Hospital, Guiyang 550002, China
- Correspondence: (J.W.); (B.L.); (X.C.); (G.Y.)
| | - Xiaojian Cao
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Correspondence: (J.W.); (B.L.); (X.C.); (G.Y.)
| | - Guoyong Yin
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Correspondence: (J.W.); (B.L.); (X.C.); (G.Y.)
| |
Collapse
|
38
|
Ong V, Swan AR, Sheppard JP, Ng E, Faung B, Diaz-Aguilar LD, Pham MH. A Comparison of Spinal Robotic Systems and Pedicle Screw Accuracy Rates: Review of Literature and Meta-Analysis. Asian J Neurosurg 2022; 17:547-556. [PMID: 36570749 PMCID: PMC9771638 DOI: 10.1055/s-0042-1757628] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction The motivation to improve accuracy and reduce complication rates in spinal surgery has driven great advancements in robotic surgical systems, with the primary difference between the newer generation and older generation models being the presence of an optical camera and multijointed arm. This study compares accuracy and complication rates of pedicle screw placement in older versus newer generation robotic systems reported in the literature. Methods We performed a systemic review and meta-analysis describing outcomes of pedicle screw placement with robotic spine surgery. We assessed the robustness of these findings by quantifying levels of cross-study heterogeneity and publication bias. Finally, we performed meta-regression to test for associations between pedicle screw accuracy and older versus newer generation robotic spine system usage. Results Average pedicle screw placement accuracy rates for old and new generation robotic platforms were 97 and 99%, respectively. Use of new generation robots was significantly associated with improved pedicle screw placement accuracy ( p = 0.03). Conclusion Accuracy of pedicle screw placement was high across all generations of robotic surgical systems. However, newer generation robots were shown to be significantly associated with accurate pedicle screw placement, showing the benefits of upgrading robotic systems with a real-time optical camera and multijointed arm.
Collapse
Affiliation(s)
- Vera Ong
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, United States
| | - Ashley Robb Swan
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, United States
| | - John P. Sheppard
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut, United States
| | - Edwin Ng
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States
| | - Brian Faung
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, United States
| | - Luis D. Diaz-Aguilar
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, United States
| | - Martin H. Pham
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, United States,Address for correspondence Martin H. Pham, MD Department of Neurological Surgery, University of CaliforniaSan Diego, 9300 Campus Point Drive, MC 7893, La Jolla, CA 92037United States
| |
Collapse
|
39
|
Guo N, Tian J, Wang L, Sun K, Mi L, Ming H, Zhe Z, Sun F. Discussion on the possibility of multi-layer intelligent technologies to achieve the best recover of musculoskeletal injuries: Smart materials, variable structures, and intelligent therapeutic planning. Front Bioeng Biotechnol 2022; 10:1016598. [PMID: 36246357 PMCID: PMC9561816 DOI: 10.3389/fbioe.2022.1016598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Although intelligent technologies has facilitated the development of precise orthopaedic, simple internal fixation, ligament reconstruction or arthroplasty can only relieve pain of patients in short-term. To achieve the best recover of musculoskeletal injuries, three bottlenecks must be broken through, which includes scientific path planning, bioactive implants and personalized surgical channels building. As scientific surgical path can be planned and built by through AI technology, 4D printing technology can make more bioactive implants be manufactured, and variable structures can establish personalized channels precisely, it is possible to achieve satisfied and effective musculoskeletal injury recovery with the progress of multi-layer intelligent technologies (MLIT).
Collapse
Affiliation(s)
- Na Guo
- Department of Computer Science and Technology, Tsinghua University, Beijing, China
- Institute of Precision Medicine, Tsinghua University, Beijing, China
| | - Jiawen Tian
- Department of Computer Science and Technology, Tsinghua University, Beijing, China
- Institute of Precision Medicine, Tsinghua University, Beijing, China
| | - Litao Wang
- College of Engineering, China Agricultural University, Beijing, China
| | - Kai Sun
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Lixin Mi
- Musculoskeletal Department, Beijing Rehabilitation Hospital, Beijing, China
| | - Hao Ming
- Orthopaedics, Chinese PLA General Hospital, Beijing, China
| | - Zhao Zhe
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Fuchun Sun
- Department of Computer Science and Technology, Tsinghua University, Beijing, China
- Institute of Precision Medicine, Tsinghua University, Beijing, China
| |
Collapse
|
40
|
Tovar MA, Dowlati E, Zhao DY, Khan Z, Pasko KBD, Sandhu FA, Voyadzis JM. Robot-assisted and augmented reality-assisted spinal instrumentation: a systematic review and meta-analysis of screw accuracy and outcomes over the last decade. J Neurosurg Spine 2022; 37:299-314. [PMID: 35213837 DOI: 10.3171/2022.1.spine211345] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of technology-enhanced methods in spine surgery has increased immensely over the past decade. Here, the authors present the largest systematic review and meta-analysis to date that specifically addresses patient-centered outcomes, including the risk of inaccurate screw placement and perioperative outcomes in spinal surgeries using robotic instrumentation and/or augmented reality surgical navigation (ARSN). METHODS A systematic review of the literature in the PubMed, EMBASE, Web of Science, and Cochrane Library databases spanning the last decade (January 2011-November 2021) was performed to present all clinical studies comparing robot-assisted instrumentation and ARSN with conventional instrumentation techniques in lumbar spine surgery. The authors compared these two technologies as they relate to screw accuracy, estimated blood loss (EBL), intraoperative time, length of stay (LOS), perioperative complications, radiation dose and time, and the rate of reoperation. RESULTS A total of 64 studies were analyzed that included 11,113 patients receiving 20,547 screws. Robot-assisted instrumentation was associated with less risk of inaccurate screw placement (p < 0.0001) regardless of control arm approach (freehand, fluoroscopy guided, or navigation guided), fewer reoperations (p < 0.0001), fewer perioperative complications (p < 0.0001), lower EBL (p = 0.0005), decreased LOS (p < 0.0001), and increased intraoperative time (p = 0.0003). ARSN was associated with decreased radiation exposure compared with robotic instrumentation (p = 0.0091) and fluoroscopy-guided (p < 0.0001) techniques. CONCLUSIONS Altogether, the pooled data suggest that technology-enhanced thoracolumbar instrumentation is advantageous for both patients and surgeons. As the technology progresses and indications expand, it remains essential to continue investigations of both robotic instrumentation and ARSN to validate meaningful benefit over conventional instrumentation techniques in spine surgery.
Collapse
Affiliation(s)
- Matthew A Tovar
- 1School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Ehsan Dowlati
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - David Y Zhao
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Ziam Khan
- 3Center for Bioinformatics and Computational Biology, University of Maryland, Baltimore County, Baltimore, Maryland; and
| | - Kory B D Pasko
- 4Georgetown University School of Medicine, Washington, DC
| | - Faheem A Sandhu
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Jean-Marc Voyadzis
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| |
Collapse
|
41
|
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The aim of this review is to present an overview of robotic spine surgery (RSS) including its history, applications, limitations, and future directions. SUMMARY OF BACKGROUND DATA The first RSS platform received United States Food and Drug Administration approval in 2004. Since then, robotic-assisted placement of thoracolumbar pedicle screws has been extensively studied. More recently, expanded applications of RSS have been introduced and evaluated. METHODS A systematic search of the Cochrane, OVID-MEDLINE, and PubMed databases was performed for articles relevant to robotic spine surgery. Institutional review board approval was not needed. RESULTS The placement of thoracolumbar pedicle screws using RSS is safe and accurate and results in reduced radiation exposure for the surgeon and surgical team. Barriers to utilization exist including learning curve and large capital costs. Additional applications involving minimally invasive techniques, cervical pedicle screws, and deformity correction have emerged. CONCLUSION Interest in RSS continues to grow as the applications advance in parallel with image guidance systems and minimally invasive techniques. IRB APPROVAL N/A.
Collapse
|
42
|
Yuan W, Meng X, Cao W, Zhu Y. Robot-Assisted Versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture: A Retrospective Study. Global Spine J 2022; 12:1151-1157. [PMID: 33375861 PMCID: PMC9210249 DOI: 10.1177/2192568220978228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To compare the clinical and radiological outcomes of robot assisted (RA) and fluoroscopy assisted (FA) percutaneous kyphoplasty (PKP) in treating single/double segment osteoporotic vertebral compression fracture (OVCF). METHODS Patients with single/double segment OVCF receiving either RA or FA PKP were evaluated retrospectively at our spine center from April 2018 to October 2019. The operation time, fluoroscopy frequency, fluoroscopy exposure time, total radiation dose, visual analogue scale (VAS), local kyphosis angle (LKA), height of fractured vertebra (HFV) and complications were compared between the single/double RA group and the FA group. RESULTS A total of 96 cases were included in this study, with 59 cases of single segment OVCF and 37 cases of double segment OVCF. For single/double segment OVCF, both RA and FA PKP could relieve pain and reduce fracture. The RA group showed lower fluoroscopy frequency, shorter fluoroscopy exposure time during operation for surgeons, better correction in LKA and HFV, lower rate of cement leakage, but more fluoroscopy frequency, fluoroscopy exposure time and radiation dose for patients compared with the FA group (P < 0.05), while the single RA group showed longer operation time compared with the FA group (P < 0.05). CONCLUSIONS For single/double segment OVCF, RA has more advantages in correcting vertebra fracture, reducing intraoperative radiation exposure for surgeons, and reducing the cement leakage rate, but it increases intraoperative radiation for patients compared with FA PKP. And FA has shorter operation time in treating single segment OVCF than RA PKP.
Collapse
Affiliation(s)
- Wei Yuan
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China,Yue Zhu and Wei Yuan, Department of Orthopedics, The First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang 110001, China. Emails: ;
| | - Xiaotong Meng
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Wenhai Cao
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Yue Zhu
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China,Yue Zhu and Wei Yuan, Department of Orthopedics, The First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang 110001, China. Emails: ;
| |
Collapse
|
43
|
Virtual and Real Bidirectional Driving System for the Synchronization of Manipulations in Robotic Joint Surgeries. MACHINES 2022. [DOI: 10.3390/machines10070530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Surgical robots are increasingly important in orthopedic surgeries to assist or replace surgeons in completing operations. During joint surgeries, the patient’s joint needs to be adjusted several times by the surgeon. Therefore, the virtual model, built on the preoperative medical images, cannot match the actual variation of the patient’s joint during the surgery. Conventional virtual reality techniques cannot fully satisfy the requirements of the joint surgeries. This paper proposes a real and virtual bidirectional driving method to synchronize the manipulations in both the real operation site and the virtual scene. The dynamic digital twin of the patient’s joint is obtained by decoupling the joint and dynamically updating its pose via the intraoperative measurements. During surgery, the surgeon can intuitively monitor the real-time position of the patient and the surgical tool through the system and can also manipulate the surgical robot in the virtual scene. In addition, the system can provide visual guidance to the surgeon when the patient’s joint is adjusted. A prototype system is developed for orthopedic surgeries. Proof-of-concept joint surgery demo is carried out to verify the effectiveness of the proposed method. Experimental results show that the proposed system can synchronize the manipulations in both the real operation site and the virtual scene, thus realizing the bidirectional driving.
Collapse
|
44
|
Wei FL, Gao QY, Heng W, Zhu KL, Yang F, Du RM, Zhou CP, Qian JX, Yan XD. Association of robot-assisted techniques with the accuracy rates of pedicle screw placement: A network pooling analysis. EClinicalMedicine 2022; 48:101421. [PMID: 35706496 PMCID: PMC9193845 DOI: 10.1016/j.eclinm.2022.101421] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Traditional paired meta-analyses have yielded inconsistent results for the safety and effectiveness of robotic-assisted pedicle screw placement due to the high heterogeneity within studies. This study evaluated the clinical effectiveness and safety of robotic-assisted pedicle screw placement. METHODS The Embase, PubMed, and Cochrane Library databases were searched with no language limitations from inception to Jan 4, 2022. Odds ratio (OR), mean difference (MD), and 95% confidence interval (CI) were used to report results. The main outcomes were accuracy of pedicle screw placement, proximal facet joint violation, and complications. The study protocol was published in PROSPERO (CRD42022301417). FINDINGS 26 trials including 2046 participants evaluating robotic-assisted pedicle screw placement were included in this study. Our pooled results showed that Renaissance (OR 2.86; [95% CI 1.79 to 4.57]) and TiRobot (OR 3.10; [95% CI 2.19 to 4.40]) yielded higher rates of perfect pedicle screw insertion (Grades A) than the conventional freehand technique. Renaissance (OR 2.82; [95% CI 1.51 to 5.25]) and TiRobot (OR 4.58; [95% CI 2.65 to 7.89]) yielded higher rates of clinically acceptable pedicle screw insertion (Grades A+B). However, ROSA, SpineAssist, and Orthobot were not associated with higher perfect pedicle screw insertion and clinically acceptable pedicle screw insertion rates. Robot-assisted techniques were associated with low rates of proximal facet joint violation (OR 0.18; [95% CI 0.10 to 0.32]; I2:9.55%) and overall complications (OR 0.38; [95% CI 0.23 to 0.63]; I2:27.05%). Moreover, robot-assisted techniques were associated with lower radiation doses (MD -14.38; [95% CI -25.62 to -3.13]; I2:100.00%). INTERPRETATION Our findings suggest that only Renaissance and TiRobot systems are associated with high accuracy rates of pedicle screw placement. Robotic-assisted techniques hold great promise in spinal surgery due to their safety and effectiveness. FUNDING This work was supported by grants from the National Natural Science Foundation of China (No. 81871818), Tangdu Hospital Seed Talent Program (Fei-Long Wei) and Natural Science Basic Research Plan in Shaanxi Province of China (No.2019JM-265).
Collapse
|
45
|
Koszulinski A, Sandoval J, Vendeuvre T, Zeghloul S, Laribi MA. Comanipulation Robotic Platform for Spine Surgery with Exteroceptive Visual Coupling: Development and Experimentation. J Med Device 2022. [DOI: 10.1115/1.4054550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
In this paper, a novel surgical robotic platform intended to assist surgeons in cervical spine surgery is presented. The purpose of this surgery is to treat cervical spine instabilities. The surgical procedure requires drilling into specific region of the vertebrae in order to attach spinal implants and ensure a normal spacing between each vertebra. In this context, the proposed robotic platform allows to control and restrict surgeon's movements to a specific drilling direction set by the surgeon. The current platform is composed of a collaborative robot with 7 DoF equipped with a drilling tool and directly comanipulated by the surgeon. A motion capture system, as an exteroceptive sensor device, provides the robot controller with the movement data of the vertebra to be drilled. Robot Operating System (ROS) framework is used to enable real-time communication between the collaborative robot and the visual exteroceptive device. In addition, an implemented compliance control program allows to enhance the safety aspect of the robotic platform. Indeed, the collaborative robot follow the patient's movements while constraining the tool movements to an optimal trajectory as well as a limited drilling depth selected by the surgeon. The robot's elbow movements are also restricted by exploiting the null-space in order to avoid collisions with other equipment or medical team members. Experimental drilling trials have been performed by an orthopedic surgeon to validate the usefulness and different functionalities of the developed robotic platform, and provide that a collaborative robot can comply with spine surgery procedure.
Collapse
Affiliation(s)
- Alizée Koszulinski
- Dept. GMSC - Pprime Institute, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Juan Sandoval
- Dept. GMSC - Pprime Institute, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Tanguy Vendeuvre
- CHU de Poitiers, Dept. GMSC - Pprime Institute, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Said Zeghloul
- Dept. GMSC - Pprime Institute, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Med Amine Laribi
- Dept. GMSC - Pprime Institute, CNRS - University of Poitiers - ENSMA, Poitiers, France
| |
Collapse
|
46
|
Su XJ, Lv ZD, Chen Z, Wang K, Zhu C, Chen H, Han YC, Song QX, Lao LF, Zhang YH, Li Q, Shen HX. Comparison of Accuracy and Clinical Outcomes of Robot-Assisted Versus Fluoroscopy-Guided Pedicle Screw Placement in Posterior Cervical Surgery. Global Spine J 2022; 12:620-626. [PMID: 32975454 PMCID: PMC9109572 DOI: 10.1177/2192568220960406] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
STUDY DESIGN This was a prospective controlled study. OBJECTIVE To compare the accuracy and clinical outcomes of robot-assisted (RA) and fluoroscopy-guided (FG) pedicle screw placement in posterior cervical surgery. METHODS This study included 58 patients. The primary outcome measures were the 1-time success rate and the accuracy of pedicle screw placement according to the Gertzbein-Robbins scales. The secondary outcome measures, including the operative time, intraoperative blood loss, hospital stay, cumulative radiation time, radiation dose, intraoperative advent events, and postoperative complications, were recorded and analyzed. The Japanese Orthopedics Association (JOA) scores and Neck Disability Index (NDI) were used to assess the neurological function of patients before and at 3 and 6 months after surgery. RESULTS The rate of grade A was significantly higher in the RA group than in the FG group (90.6% and 71.1%; P < .001). The clinically acceptable accuracy was 97.2% in the RA group and 90.7% in the FG group (P = .009). Moreover, the 1-time success rate was significantly higher in the RA group than in the FG group. The RA group had less radiation time (P < .001) and less radiation dose (P = .002) but longer operative time (P = .001). There were no significant differences in terms of intraoperative blood loss, hospital stay, intraoperative adverse events, postoperative complications, JOA scores, and NDI scores at each follow-up time point between the 2 groups. CONCLUSIONS The RA technique achieved higher accuracy and 1-time success rate of pedicle screw placement in posterior cervical surgery while achieving comparable clinical outcomes.
Collapse
Affiliation(s)
- Xin-Jin Su
- Shanghai Jiao Tong
University, Shanghai, China
| | | | - Zhi Chen
- Shanghai Jiao Tong
University, Shanghai, China
| | - Kun Wang
- Shanghai Jiao Tong
University, Shanghai, China
| | - Chao Zhu
- Shanghai Jiao Tong
University, Shanghai, China
| | - Hao Chen
- Shanghai Jiao Tong
University, Shanghai, China
| | | | | | - Li-Feng Lao
- Shanghai Jiao Tong
University, Shanghai, China
| | | | - Quan Li
- Shanghai Jiao Tong
University, Shanghai, China
| | - Hong-Xing Shen
- Shanghai Jiao Tong
University, Shanghai, China,Hong-Xing Shen, Department of Spine Surgery,
Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian
Road, Shanghai, 200127, China.
| |
Collapse
|
47
|
Su YF, Tsai TH, Lieu AS, Lin CL, Chang CH, Tsai CY, Su HY. Bone-Mounted Robotic System in Minimally Invasive Spinal Surgery for Osteoporosis Patients: Clinical and Radiological Outcomes. Clin Interv Aging 2022; 17:589-599. [PMID: 35497053 PMCID: PMC9041149 DOI: 10.2147/cia.s359538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/11/2022] [Indexed: 01/02/2023] Open
Abstract
Purpose Severe complications, including screw loosening events and low fusion rates, in spinal fusion surgery using the traditional open method are problematic. This retrospective study aimed to evaluate the rate of screw loosening and the clinical outcomes of bone-mounted miniature robot-assisted pedicle screw placement in patients treated for degenerative spinal disease. Patients and Methods Data were collected from the medical records of 118 patients (mean age, 69 years). Differences in clinical outcomes, including the Oswestry disability index, visual analog scale score, screw loosening rate, cage fusion rate, and complications, were evaluated among different bone mineral densities. Results The screw loosening and cage fusion rates for all patients, normal bone mineral density, osteopenia, and osteoporosis groups were 12%, 8.6%, 13.1%, and 14%, respectively, and 85.3%, 93%, 82.5%, and 81.4%, respectively. There was a higher screw loosening rate and a lower cage fusion rate in the osteopenia and osteoporosis groups than in the normal bone density group. The accuracy of the screw placement was 97.3%. There were no statistically significant differences in the Oswestry disability index and visual analog scale scores, and no major complications for dural tear or vascular or visceral injury. Conclusion Our study demonstrated an acceptable screw loosening rate in patients with osteoporosis compared to that in patients with normal bone mineral density. The robotic system resulted in accurate screw placement in patients with osteoporosis.
Collapse
Affiliation(s)
- Yu-Feng Su
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tai-Hsin Tsai
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ann-Shung Lieu
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Lung Lin
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Hui Chang
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Yu Tsai
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Ph.D. Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan
- Post Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Correspondence: Cheng-Yu Tsai; Hui-Yuan Su, Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan, Tel +886-7-3215049, Fax +886-7-3215039, Email ;
| | - Hui-Yuan Su
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
48
|
Cunningham BW, Brooks DM. Comparative Analysis of Optoelectronic Accuracy in the Laboratory Setting Versus Clinical Operative Environment: A Systematic Review. Global Spine J 2022; 12:59S-74S. [PMID: 35393881 PMCID: PMC8998481 DOI: 10.1177/21925682211035083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The optoelectronic camera source and data interpolation process serve as the foundation for navigational integrity in robotic-assisted surgical platforms. The current systematic review serves to provide a basis for the numerical disparity observed when comparing the intrinsic accuracy of optoelectronic cameras versus accuracy in the laboratory setting and clinical operative environments. METHODS Review of the PubMed and Cochrane Library research databases was performed. The exhaustive literature compilation obtained was then vetted to reduce redundancies and categorized into topics of intrinsic accuracy, registration accuracy, musculoskeletal kinematic platforms, and clinical operative platforms. RESULTS A total of 465 references were vetted and 137 comprise the basis for the current analysis. Regardless of application, the common denominators affecting overall optoelectronic accuracy are intrinsic accuracy, registration accuracy, and application accuracy. Intrinsic accuracy equaled or was less than 0.1 mm translation and 0.1 degrees rotation per fiducial. Controlled laboratory platforms reported 0.1 to 0.5 mm translation and 0.1 to 1.0 degrees rotation per array. Accuracy in robotic-assisted spinal surgery reported 1.5 to 6.0 mm translation and 1.5 to 5.0 degrees rotation when comparing planned to final implant position. CONCLUSIONS Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of robotic-assisted spinal surgery. Transitioning from controlled laboratory to clinical operative environments requires an increased number of steps in the optoelectronic kinematic chain and error potential. Diligence in planning, fiducial positioning, system registration and intra-operative workflow have the potential to improve accuracy and decrease disparity between planned and final implant position.
Collapse
Affiliation(s)
- Bryan W. Cunningham
- Department of Orthopaedic Surgery, Musculoskeletal Research and Innovation Institute, MedStar Union Memorial Hospital, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Daina M. Brooks
- Department of Orthopaedic Surgery, Musculoskeletal Research and Innovation Institute, MedStar Union Memorial Hospital, Baltimore, MD, USA
| |
Collapse
|
49
|
Lee NJ, Leung E, Buchanan IA, Geiselmann M, Coury JR, Simhon ME, Zuckerman S, Buchholz AL, Pollina J, Jazini E, Haines C, Schuler TC, Good CR, Lombardi J, Lehman RA. A multicenter study of the 5-year trends in robot-assisted spine surgery outcomes and complications. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:9-20. [PMID: 35441099 PMCID: PMC8990386 DOI: 10.21037/jss-21-102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/12/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND Although a growing amount of literature that suggests robots are safe and can achieve comparable outcomes to conventional techniques, much of this literature is limited by small sample sizes and single-surgeon or single center series. Furthermore, it is unclear what the impact of robotic technology has made on operative and clinical outcomes over time. This is the first and largest multicenter study to examine the trends in outcomes and complications after robot-assisted spine surgery over a 5-year period. METHODS Adult (≥18 years old) patients who underwent spine surgery with robot-assistance between 2015 and 2019 at four unique spine centers. The robotic systems used included the Mazor Renaissance, Mazor X, and Mazor Stealth Edition. Patients with incomplete data were excluded from this study. The minimum follow-up was 90 days. RESULTS A total of 722 adult patients were included (117 Renaissance, 477 X, 128 Stealth). Most patient and operative factors (e.g., sex, tobacco status, total instrumented levels, and pelvic fixation,) were similar across the years. Mean ± standard deviation Charlson comorbidity index (CCI) was 1.5±1.5. The most commonly reported diagnoses included high grade spondylolisthesis (40.6%), degenerative disc disease (18.4%), and degenerative scoliosis (17.6%). Mean (standard deviation) number of instrumented levels was 3.8±3.4. From 2015 to 2019, average robot time per screw improved from 7.2 to 5.5 minutes (P=0.004, R2=0.649). Average fluoroscopy time per screw improved from 15.2 to 9.4 seconds (P=0.002). Rates of both intraoperative screw exchange for misplaced screw (2015-2016: 2.7%, 2019: 0.8%, P=0.0115, R2=0.1316) and robot abandonment (2015-2016: 7.1%, 2019: 1.1%, P=0.011, R2=0.215) improved significantly over time. The incidence of other intraoperative complications (e.g., dural tear, loss of motor/sensory function, blood transfusion) remained consistently low, but similar throughout the years. The length of stay (LOS) decreased by nearly 1 day from 2015 to 2019 (P=0.007, R2=0.779). 90-day reoperation rates did not change significantly. CONCLUSIONS At four institutions among seven surgeons, we demonstrate robot screw accuracy, reliability, operative efficiency, and radiation exposure improved significantly from 2015 to 2019. 90-day complication rates remained low and LOS decreased significantly with time. These findings further validate continued usage of robot-assisted spine surgery and the path toward improved value-based care.
Collapse
Affiliation(s)
- Nathan J. Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Eric Leung
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ian A. Buchanan
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Matthew Geiselmann
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Josephine R. Coury
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Matthew E. Simhon
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Scott Zuckerman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Avery L. Buchholz
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - John Pollina
- Department of Neurosurgery, State University of New York, Buffalo, NY, USA
| | - Ehsan Jazini
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | - Colin Haines
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | - Thomas C. Schuler
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | | | - Joseph Lombardi
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ronald A. Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| |
Collapse
|
50
|
Himstead AS, Shahrestani S, Brown NJ, Produturi G, Shlobin NA, Al Jammal O, Choi EH, Ransom SC, Daniel Diaz-Aguilar L, Sahyouni R, Abraham M, Pham MH. Bony fixation in the era of spinal robotics: A systematic review and meta-analysis. J Clin Neurosci 2022; 97:62-74. [DOI: 10.1016/j.jocn.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/01/2022] [Accepted: 01/08/2022] [Indexed: 01/02/2023]
|