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Sinz NJ, Hwang RW, Lee GH, Baker KC, Arnold P, Sasso R, Park D, Fischgrund J, Niu R, Kim DH. Pedicle Screw-Associated Violation of the Adjacent Unfused Facet Joint: Clinical Outcomes and Fusion Rates. Global Spine J 2024; 14:1477-1484. [PMID: 36510742 DOI: 10.1177/21925682221145651] [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] [Indexed: 12/15/2022] Open
Abstract
STUDY DESIGN Retrospective review of a prospective randomized trial. OBJECTIVES To compare outcome scores and fusion rates in patients with and without pedicle screw-associated facet joint violation (FJV) after a single-level lumbar fusion. METHODS Clinical outcomes data and computed tomography (CT) imaging were reviewed for 157 patients participating in a multicenter prospective trial. Post-operative CT scans at 12-months follow-up were examined for fusion status and FJV. Patient-reported outcomes (PROs) included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for leg and low back pain. Chi-square test of independence was used to compare proportions between groups on categorical measures. Two-sample t-test was used to identify differences in mean patient outcome scores. Logistic regression models were performed to determine association between FJV and fusion rates. RESULTS Of the 157 patients included, there were 18 (11.5%) with FJV (Group A) and 139 (88.5%) without FJV (Group B). Patients with FJV experienced less improvement in ODI (P = .004) and VAS back pain scores (P = .04) vs patients without FJV. There was no difference in mean VAS leg pain (P = .4997). The rate of fusion at 12-months for patients with FJV (27.8%) was lower compared to those without FJV (71.2%) (P = .0002). Patients with FJV were 76% less likely to have a successful fusion at 12-months. CONCLUSION Pedicle screw-associated violation of the adjacent unfused facet joint during single-level lumbar fusion is associated with less improvement in back pain, back pain-associated disability, and a lower fusion rate at 1-year after surgery.
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Affiliation(s)
- Nathan J Sinz
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | - Raymond W Hwang
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Gyu-Ho Lee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin C Baker
- Bone & Joint Center, Dept. of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Paul Arnold
- Carle Neuroscience Institute, Urbana, IL, USA
| | - Rick Sasso
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IL, USA
| | - Daniel Park
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA
| | - Jeffrey Fischgrund
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA
| | - Ruijia Niu
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - David H Kim
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
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Messner IM, Keuschnigg P, Stöllinger B, Kraihamer M, Coste-Marin J, Huber P, Kellner D, Kreuzeder EM, Steininger P, Deutschmann H. Investigating focal spot position drift in a mobile imaging system equipped with a monobloc-based x-ray generator. Med Phys 2024; 51:3578-3589. [PMID: 38014777 DOI: 10.1002/mp.16859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Misalignment or double-contouring artifacts can appear in high-resolution 3D cone beam computed tomography (CBCT) images, potentially indicating geometric accuracy issues in the projection data. Such artifacts may go unnoticed in low-resolution images and could be associated with changes in the focal spot (FS) position. PURPOSE High-resolution 3D-CBCT imaging by a mobile imaging device with a large gantry clearance offers more versatility for clinical workflows in image-guided brachytherapy (IGBT), intraoperative radiation therapy (IORT), and spinal, as well as maxillofacial surgery. However, misalignment or double-contouring artifacts hinder workflow advancements in these domains. This paper introduces intrinsic calibration and geometrical correction methods as extensions to a well-established technique for addressing geometrical deviations resulting from factors such as gravity or mechanical inconsistencies. These extensions cover shifts and drifts of the FS depending on FS size selection, temperature, tube current, and tube potential. The proposed methods effectively mitigate artifacts in high-resolution CBCT images stemming from geometrical inaccuracies in projection data, without requiring additional equipment like a pinhole device. METHODS Geometrical offsets and drifts of the x-ray tube FS were characterized on a mobile multi-purpose imaging system, the ImagingRing-m. A pinhole-like experiment was simulated by adjusting the movable collimation unit to a small rectangular aperture within the FS size range. The influence of filament selection, that is, FS size, temperature, the relatively low tube currents, as well as tube potential settings have been studied on two different monobloc types sharing the same x-ray tube insert. The Catphan 504 and an Alderson head phantom were used to assess resulting image artifacts. RESULTS Switching the FS size to one different from what was used for geometrical (gravitation, mechanical variations) calibration induced the most notable position changes of the x-ray FS, resulting in double-contouring artifacts and blurring of high-resolution 3D-CBCT images. Incorporating these shifts into a geometrical correction method effectively minimized these artifacts. Thermal drifts exhibited the second largest geometrical changes, comparable to FS size shifts across the thermal operating conditions of the x-ray system. The proposed thermal drift compensation markedly reduced thermal drift effects. Tube current and potential had little impact within the range of available tube currents, eliminating the need for compensation in current applications. CONCLUSIONS Augmenting the geometrical calibration pipeline with proposed FS drift compensations yielded significant enhancements in image quality for high-resolution reconstructions. While compensation for thermal effects posed challenges, it proved achievable. The roles of tube current and potential were found to be negligible.
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Affiliation(s)
- Ivan Michael Messner
- Institute for Research and Development on Advanced Radiation Technologies (radART), Paracelsus Medical University, Salzburg, Austria
- medPhoton GmbH, Salzburg, Austria
| | | | | | | | | | | | | | | | - Philipp Steininger
- Institute for Research and Development on Advanced Radiation Technologies (radART), Paracelsus Medical University, Salzburg, Austria
- medPhoton GmbH, Salzburg, Austria
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Wu J, Fan M, He D, Wei Y, Duan F, Jiang X, Tian W. Accuracy and clinical characteristics of robot-assisted cervical spine surgery: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06179-4. [PMID: 38613575 DOI: 10.1007/s00264-024-06179-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE To evaluate the accuracy and feasibility of robot-assisted cervical screw placement and factors that may affect the accuracy. METHODS A comprehensive search was made on PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang Med for the selection of potential eligible literature. The outcomes were evaluated in terms of the relative risk (RR) or standardized mean difference (MD) and corresponding 95% confidence interval (CI). Subgroup analyses of the accuracy of screw placement at different cervical segments and with different screw placement approaches were performed. A comparison was made between robotic navigation and conventional freehand cervical screw placement. RESULTS Six comparative cohort studies and five case series studies with 337 patients and 1342 cervical screws were included in this study. The perfect accuracy was 86% (95% CI, 82-89%) and the clinically acceptable rate was 98% (95% CI, 95-99%) in robot-assisted cervical screw placement. The perfect accuracy of robot-assisted C1 lateral mass screw placement was the highest (96%), followed by C6-7 pedicle screw placement (93%) and C2 pedicle screw placement (86%), and the lowest was C3-5 pedicle screw placement (75%). The open approach had a higher perfect accuracy than the percutaneous/intermuscular approach (91% vs 83%). Compared with conventional freehand cervical screw placement, robot-assisted cervical screw placement had a higher accuracy, a lower incidence of perioperative complications, and less intraoperative blood loss. CONCLUSION With good collaboration between the operator and the robot, robot-assisted cervical screw placement is accurate and feasible. Robot-assisted cervical screw placement has a promising prospect.
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Affiliation(s)
- Jiayuan Wu
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Da He
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
| | - Yi Wei
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Fangfang Duan
- Epidemiological Research Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Xieyuan Jiang
- Trauma Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
- Beijing Jishuitan Orthopaedic Robot Engineering Research Center Co., Ltd, Beijing, 100035, China
| | - Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
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Choi H, Kim S, Jang W. User Experience Evaluation of a Spinal Surgery Robot: Workload, Usability, and Satisfaction Study. JMIR Hum Factors 2024; 11:e54425. [PMID: 38432688 PMCID: PMC11019418 DOI: 10.2196/54425] [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: 11/27/2023] [Revised: 02/07/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Robotic spine surgery has continued to evolve since its US Food and Drug Administration approval in 2004, with products now including real-time video guidance and navigation during surgery. As the market for robotic surgical devices evolves, it is important to consider usability factors. OBJECTIVE The primary objective of this study was to determine the user experience of a surgical-assistive robotic device. The secondary objective was to evaluate workload, usability, the After-Scenario Questionnaire (ASQ), and the System Usability Scale (SUS). In addition, this study compares the workload, usability, and satisfaction survey of the device among different occupational groups using the device. METHODS Doctors (n=15) and nurses (n=15), the intended users of the surgical assistant robot, participated in the usability evaluation. Participants performed essential scenarios for the surgical assistant robot and provided scenario-specific satisfaction (ASQ), workload (NASA Task Load Index), and usability (SUS) scores. RESULTS Both doctors and nurses had task success rates of 85% or higher for each scenario. ASQ results showed that both doctors and nurses were least satisfied with ease of completing the task of registration (group 1: mean 4.73, SD 1.57 and group 2: mean 4.47, SD 1.8), amount of time it took (group 1: mean 4.47, SD 1.63 and group 2: mean 4.40, SD 2.09), and support information satisfaction (group 1: mean 5.13, SD 1.50 and group 2: mean 5.13, SD 1.89). All participants had low workloads, and the overall Task Load Index score had a P value of .77, which is greater than .05. The SUS results showed that the overall usability mean for doctors was 64.17 (SD 16.52) and the mean for nurses was 61.67 (SD 19.18), with a P value of .84, which is greater than .05, indicating no difference between the 2 groups. CONCLUSIONS In this study, doctors and nurses evaluated the interaction of the device in a simulated environment, the operating room. By evaluating the use experience and usability of the device with real intended users, we can develop a more effective and convenient user interface.
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Affiliation(s)
- Hyeonkyeong Choi
- Department of Medical Device Engineering and Management, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seunghee Kim
- Department of Medical Device Engineering and Management, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wonseuk Jang
- Department of Medical Device Engineering and Management, Yonsei University College of Medicine, Seoul, Republic of Korea
- Medical Device Usability Research Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Liang M, Zhang X, Liu H, Gao R, Guo D, Yao Z. Robot-assisted Temporary Hemiepiphysiodesis With Eight-plates for Lower Extremity Deformities in Children. J Pediatr Orthop 2024; 44:260-266. [PMID: 38312109 DOI: 10.1097/bpo.0000000000002631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
PURPOSE This study was performed to compare the radiographic results of robot-assisted and traditional methods of treating lower extremity deformities (LEDs). METHODS From January 2019 to February 2022, 55 patients with LEDs were treated by temporary hemiepiphysiodesis with eight-plates. They were divided into a robot group and a freehand group. The fluoroscopy time and operation time were recorded. The accuracy of screw placement was measured after the operation using the following parameters: coronal entering point (CEP), sagittal entering point (SEP), and angle between the screw and epiphyseal plate (ASEP). The limb length discrepancy (LLD) and femorotibial angle (FTA) were measured before the operation, after the operation, and at the last follow-up. Patients were followed up for 12 to 24 months, and the radiographic results of the 2 groups were compared. RESULTS Among the 55 patients with LEDs, 36 had LLD and 19 had angular deformities. Seventy-six screws were placed in the robot group and 85 in the freehand group. There was no difference in the CEP between the 2 groups ( P >0.05). The robot group had a better SEP (2.96±1.60 vs. 6.47±2.80 mm) and ASEP (3.46°±1.58° vs. 6.92°±3.92°) than the freehand group ( P <0.001). At the last follow-up, there was no difference in the LLD or FTA improvement between the two groups ( P >0.05). The incidence of complications was significantly lower in the robot group than in the freehand group (0/27 vs. 5/28, P <0.05). CONCLUSION Robot-assisted temporary hemiepiphysiodesis with eight-plates is a safe and effective method for treating LEDs in children. Robotic placement of screws is superior to freehand placement with respect to the entering position and direction. Although the correction effect for LLD and angular deformity is similar, screw dislocation is less common when using robot assistance. LEVELS OF EVIDENCE Level-III. Retrospective comparative study.
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Affiliation(s)
- Mingqian Liang
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Hwang YH, Ha BJ, Kim HC, Lee BH, Park JY, Chin DK, Yi S. A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques. Neurospine 2024; 21:83-94. [PMID: 38569633 PMCID: PMC10992644 DOI: 10.14245/ns.2448036.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE This study aimed to compare the accuracy of robotic spine surgery and conventional pedicle screw fixation in lumbar degenerative disease. We evaluated clinical and radiological outcomes to demonstrate the noninferiority of robotic surgery. METHODS This study employed propensity score matching and included 3 groups: robot-assisted mini-open posterior lumbar interbody fusion (PLIF) (robotic surgery, RS), c-arm guided minimally invasive surgery transforaminal lumbar interbody fusion (C-arm guidance, CG), and freehand open PLIF (free of guidance, FG) (54 patients each). The mean follow-up period was 2.2 years. The preoperative spine condition was considered. Accuracy was evaluated using the Gertzbein-Robbins scale (GRS score) and Babu classification (Babu score). Radiological outcomes included adjacent segmental disease (ASD) and mechanical failure. Clinical outcomes were assessed based on the visual analogue scale, Oswestry Disability Index, 36-item Short Form health survey, and clinical ASD rate. RESULTS Accuracy was higher in the RS group (p < 0.01) than in other groups. The GRS score was lower in the CG group, whereas the Babu score was lower in the FG group compared with the RS group. No significant differences were observed in radiological and clinical outcomes among the 3 groups. Regression analysis identified preoperative facet degeneration, GRS and Babu scores as significant variables for radiological and clinical ASD. Mechanical failure was influenced by the GRS score and patients' age. CONCLUSION This study showed the superior accuracy of robotic spine surgery compared with conventional techniques. When combined with minimally invasive surgery, robotic surgery is advantageous with reduced ligament and muscle damage associated with traditional open procedures.
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Affiliation(s)
- Yoon Ha Hwang
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Jin Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Hyung Cheol Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Byung Ho Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
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Vadalà G, Papalia GF, Russo F, Brigato P, Ambrosio L, Papalia R, Denaro V. Intraoperative Cone-Beam Computed Tomography Navigation Versus 2-Dimensional Fluoroscopy in Single-Level Lumbar Spinal Fusion: A Comparative Analysis. Neurospine 2024; 21:76-82. [PMID: 38569632 PMCID: PMC10992660 DOI: 10.14245/ns.2347106.553] [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: 10/24/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Several studies have advocated for the higher accuracy of transpedicular screw placement under cone-beam computed tomography (CBCT) compared to conventional 2-dimensional (2D) fluoroscopy. The superiority of navigation systems in perioperative and postoperative outcomes remains a topic of debate. This study aimed to compare operative time, screw placement time and accuracy, total radiation dose, perioperative and postoperative outcomes in patients who underwent transpedicular screw fixation for degenerative lumbar spondylolisthesis (DLS) using intraoperative CBCT navigation versus 2D fluoroscopy. METHODS A retrospective analysis was conducted on patients affected by single-level DLS who underwent posterior lumbar instrumentation with transpedicular screw fixation using surgical CBCT navigation (NV group) or 2D fluoroscopy-assisted freehand technique (FH group). Demographics, screw placement time and accuracy, operative time, total radiation dose, intraoperative blood loss, screw revision rate, complications, and length of stay (LOS) were assessed. RESULTS The study included a total of 30 patients (NV group: n = 15; FH group: n = 15). The mean screw placement time, operative time, and LOS were significantly reduced in the NV group compared to the FH group (p < 0.05). The total radiation dose was significantly higher in the NV group (p < 0.0001). No significant difference was found in terms of blood loss and postoperative complications. CONCLUSION This study suggests that intraoperative CBCT-navigated single-level lumbar transpedicular screw fixation is superior in terms of mean screw placement time, operative time, and LOS compared to 2D fluoroscopy, despite a higher intraoperative radiation exposure.
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Affiliation(s)
- Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Giuseppe Francesco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Fabrizio Russo
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Paolo Brigato
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Rocco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
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Oh JYL. Commentary on "A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques". Neurospine 2024; 21:95-96. [PMID: 38569634 PMCID: PMC10992638 DOI: 10.14245/ns.2448240.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
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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.
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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
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Loniewski S, Farah K, Mansouri N, Albader F, Settembre N, Litré CF, Malikov S, Fuentes S. Da Vinci Robotic Assistance for Anterolateral Lumbar Arthrodesis: Results of a French Multicentric Study. World Neurosurg 2024; 181:e685-e693. [PMID: 37898271 DOI: 10.1016/j.wneu.2023.10.114] [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: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The da Vinci robot (DVR) is the most widely used robot in abdominal, urological, and gynecological surgery. Due to its minimally invasive approach, the DVR has demonstrated its effectiveness and improved safety in these different disciplines. The aim of our study was to report its use in an anterior approach of complex lumbar surgery. METHODS In a retrospective multicenter observational study, 10 robotic-assisted procedures were performed from March 2021 to May 2022. Six oblique lumbar interbody fusion procedures and 4 lumbar corpectomies were performed by anterolateral approach assisted by the DVR. The characteristics of the patients and the intraoperative and postoperative data were recorded. RESULTS Six men and 4 women underwent surgery (mean age 50.5 years; body mass index 28.6 kg/m2). No vascular injuries were reported, and no procedures required conversion to open surgery. Mean surgical time were 219 minutes for 1-level oblique lumbar interbody fusion (3 patients), 286 minutes for 2-level oblique lumbar interbody fusion (3 patients), and 390 minutes for corpectomy (4 patients). Four patients experienced nonserious adverse events due to lumbar plexus nerve damage. One patient had a vertebral body plate fracture requiring posterior revision surgery, and 1 patient had a psoas hematoma requiring transfusion. No abdominal wall complications or surgical site infection were found. Seven patients were reviewed at 12 months, none had complications, and all showed radiological evidence of fusion. CONCLUSIONS The use of the DVR in lumbar surgery allows a safe minimally invasive transperitoneal approach, but to date, only hybrid procedures have been performed.
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Affiliation(s)
- Stanislas Loniewski
- Department of Neurosurgery, Hôpital Maison Blanche, CHU de Reims, Reims, France.
| | - Kaissar Farah
- Department of Neurosurgery, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Nacer Mansouri
- Department of Neurosurgery, Hôpital Central, CHRU Nancy, Nancy, France
| | - Faisal Albader
- Department of Neurosurgery, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Nicla Settembre
- Department of Vascular surgery, Hôpitaux de Brabois, CHRU Nancy, Nancy, France
| | - Claude-Fabien Litré
- Department of Neurosurgery, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | - Serguei Malikov
- Department of Vascular surgery, Hôpitaux de Brabois, CHRU Nancy, Nancy, France
| | - Stéphane Fuentes
- Department of Neurosurgery, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
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Zhang ZG, Zhou LP, Kang L, Shen CL. Letter to the Editor Regarding "A Comparison of Percutaneous Pedicle Screw Accuracy Between Robotic Navigation and Novel Fluoroscopy-Based Instrument Tracking for Patients Undergoing Instrumented Thoracolumbar Surgery". World Neurosurg 2024; 181:191-192. [PMID: 38229280 DOI: 10.1016/j.wneu.2023.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Zhi-Gang Zhang
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lu-Ping Zhou
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Liang Kang
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Cai-Liang Shen
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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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.
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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
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Carbone M, Viglialoro RM, Stagnari S, Condino S, Gesi M, Scaglione M, Parchi PD. Design, Fabrication, and Preliminary Validation of Patient-Specific Spine Section Phantoms for Use in Training Spine Surgeons Outside the Operating Room/Theatre. Bioengineering (Basel) 2023; 10:1345. [PMID: 38135936 PMCID: PMC10740604 DOI: 10.3390/bioengineering10121345] [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: 10/17/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Pedicle screw fixation (PSF) demands rigorous training to mitigate the risk of severe neurovascular complications arising from screw misplacement. This paper introduces a patient-specific phantom designed for PSF training, extending a portion of the learning process beyond the confines of the surgical room. Six phantoms of the thoracolumbar region were fabricated from radiological datasets, combining 3D printing and casting techniques. The phantoms were employed in three training sessions by a fifth-year resident who performed full training on all six phantoms; he/she placed a total of 57 pedicle screws. Analysis of the learning curve, focusing on time per screw and positioning accuracy, revealed attainment of an asymptotic performance level (around 3 min per screw) after 40 screws. The phantom's efficacy was evaluated by three experts and six residents, each inserting a minimum of four screws. Initial assessments confirmed face, content, and construct validity, affirming the patient-specific phantoms as a valuable training resource. These proposed phantoms exhibit great promise as an essential tool in surgical training as they exhibited a demonstrable learning effect on the PSF technique. This study lays the foundation for further exploration and underscores the potential impact of these patient-specific phantoms on the future of spinal surgical education.
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Affiliation(s)
- Marina Carbone
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Rosanna Maria Viglialoro
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Sara Stagnari
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Sara Condino
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Marco Gesi
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, 56121 Pisa, Italy;
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Michelangelo Scaglione
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Paolo Domenico Parchi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
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Gilani S, Mohamed M, Hartley B, Zamora R, Zou J, Daccarett M, Carlson JB. The Use of a Robotic Arm for Fixation of Pelvic Fractures. J Orthop Trauma 2023; 37:S28-S32. [PMID: 37828699 DOI: 10.1097/bot.0000000000002691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate unplanned cortical or neuroforaminal violation of iliosacral and transsacral screw placement using fluoroscopy versus screw placement using a robotic arm. DESIGN This is a prospective cohort study. SETTING Single surgeon, single North American level 1 trauma center. PATIENTS Radiographic and clinical data for 21 consecutive adult trauma patients with pelvic ring fractures undergoing surgical treatment were prospectively collected. Treatment consisted of iliosacral and/or transsacral screws with or without anterior fixation. INTERVENTION Ten patients were treated with the assistance of a robotic arm. Eleven patients were treated with standard fluoroscopic techniques. MAIN OUTCOME MEASUREMENTS Thirty-two screws were placed and evaluated with postoperative computed tomography or O-arm spins to assess unplanned cortical or neuroforaminal violation. Violations were graded according to the Gertzbein and Robbins system for pedicle screw violation, categorizing screw violation in 2-mm increments. The postoperative images were blindly reviewed by 5 fellowship-trained orthopaedic traumatologists. The treating surgeon was excluded from review. RESULTS The Mann-Whitney U test on the Gertzbein and Robbins system results demonstrated significantly (P = 0.02) fewer violations with robotic assistance. χ2 analysis of whether there was a cortical violation of any distance demonstrated significantly (P = 0.003) fewer cortical violations with robotic assistance. There were no neurovascular injuries in either group. CONCLUSION Robotic assistance demonstrated significantly fewer unplanned cortical or neuroforaminal violations. Further research is needed with additional surgeons and sites to evaluate the accuracy of iliosacral and transsacral screw placement with robotic assistance. LEVEL OF EVIDENCE Therapeutic, level II.
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Affiliation(s)
- Syed Gilani
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY
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Ryvlin J, Shin JH, Yassari R, De la Garza Ramos R. Editorial: Artificial intelligence and advanced technologies in neurological surgery. Front Surg 2023; 10:1251086. [PMID: 37533743 PMCID: PMC10392845 DOI: 10.3389/fsurg.2023.1251086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023] Open
Affiliation(s)
- Jessica Ryvlin
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - John H. Shin
- Department of Neurological Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Rafael De la Garza Ramos
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
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Romagna A, Sperker S, Lumenta C, Tomasino A, Schwartz C, Lehmberg J, Zausinger S, Schul D. Robot-assisted versus navigated transpedicular spine fusion: A comparative study. Int J Med Robot 2023; 19:e2500. [PMID: 36649651 DOI: 10.1002/rcs.2500] [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: 11/14/2022] [Revised: 12/29/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to compare the intraoperative and postoperative outcomes between a robot-assisted versus a navigated transpedicular fusion technique. METHODS This retrospective analysis included patients who underwent transpedicular posterior fusion of the spine due to trauma, pyogenic spondylodiscitis and osteoporosis. Surgery was done either with a robot-assisted or a percutaneous navigated transpedicular fusion technique. The outcome analysis included the duration of surgery, the radiation exposure, the postoperative screw position and complications. RESULTS A total of 60 patients were operated and 491 screws were analysed. No statistical difference was seen in the applied cumulative effective radiation dose per patient. The radiological assessment revealed a more accurate screw placement with robot assistance. A learning curve could be observed in robot-assisted fusion. CONCLUSION Robot-assisted and navigated transpedicular fusion techniques are both effective and safe. Robot-assisted transpedicular spine fusion goes along with higher placement accuracy but its implementation needs an adequate learning curve.
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Affiliation(s)
- Alexander Romagna
- Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany.,Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sarah Sperker
- Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany
| | | | - Andre Tomasino
- Department of Neurosurgery, Inn Klinikum Altötting und Mühldorf, Mühldorf, Germany
| | - Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Jens Lehmberg
- Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany
| | | | - David Schul
- Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany
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