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Russo F, Nardi N, Papalia GF, Papalia R, Vadalà G, Denaro V. Deviation from preoperative planning and pedicle screw accuracy in navigated and robotic spinal fusion: a systematic review. 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 2025; 34:1890-1899. [PMID: 40199753 DOI: 10.1007/s00586-025-08822-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/28/2025] [Accepted: 03/24/2025] [Indexed: 04/10/2025]
Abstract
PURPOSE Image-guided navigation and robotic systems have been introduced in spinal surgery to increase the accuracy of pedicle screws placement and reduce the rate of complications. The objective of this study is to evaluate the different final screw deviation from pre-operative planning and the associated pedicle screw accuracy in spinal fusion surgery assisted by image-guided navigation or robotic systems. METHODS The systematic literature search was executed using PubMed-Medline, Cochrane Central, and Scopus on 30 April 2023. Studies that explored the deviation between final position and preoperative planning of pedicle screws assisted by image-guide navigation or robotic system were included. The data extracted were surgical approach, surgical aid, number of screws evaluated, spinal levels, accuracy and deviation of screws. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) or the methodological index for non-randomized studies (MINORS) score. RESULTS This review included 15 studies, of which 5 used navigation and 10 robotic system. The studies involved 1487 patients, with the evaluation of a total of 7274 pedicle screws, with an assessment of planning and final position. The different methodologies to calculate the deviation include angular deviations in the axial and sagittal plane, 3D angular deviation, and tip and entry point deviation. Regarding screw accuracy, 98.15% of the screws were grade A or B, and 1.85% as category C or D. CONCLUSION Although preoperative planning allows the surgeon to plan the final position of the screw most appropriately, mild deviations from it do not seem to excessively influence the accuracy of the spinal fusion.
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Affiliation(s)
- Fabrizio Russo
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128, Roma, Italy
| | - Niccolò Nardi
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128, Roma, Italy
| | - Giuseppe Francesco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128, Roma, Italy
| | - Rocco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128, Roma, Italy
| | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128, Roma, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128, Roma, Italy.
- Department of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128, Roma, Italy
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Riewruja K, Tanasansomboon T, Yingsakmongkol W, Kotheeranurak V, Limthongkul W, Chokesuwattanaskul R, Kerr SJ, Singhatanadgige W. A Network Meta-Analysis Comparing the Efficacy and Safety of Pedicle Screw Placement Techniques Using Intraoperative Conventional, Navigation, Robot-Assisted, and Augmented Reality Guiding Systems. Int J Spine Surg 2024; 18:551-570. [PMID: 39079746 PMCID: PMC11616373 DOI: 10.14444/8618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2024] Open
Abstract
BACKGROUND Studies were reviewed and collected to compare different image guidance systems for pedicle screw placement (PSP) regarding accuracy and safety outcomes. Included were conventional, navigation, robot-assisted, and recent technology such as augmented reality (AR) guiding systems. METHODS This network meta-analysis obtained human comparative studies and randomized controlled trials (RCTs) regarding PSP found in 3 databases (Cochrane, PubMed, and Scopus). Data extraction for accuracy, safety, and clinical outcomes were collected. The network meta-analysis was analyzed, and a surface under the cumulative ranking curve (SUCRA) was used to rank the treatment for all outcomes. RESULTS The final 61 studies, including 13 RCTs and 48 non-RCTs, were included in the meta-analysis. These studies included a total of 17,023 patients and 35,451 pedicle screws. The surface under the cumulative ranking curve ranking demonstrated the supremacy of robotics in almost all accuracy outcomes except for the facet joint violation. Regarding perfect placement, the risk difference for AR was 19.1 (95% CI: 8.1-30.1), which was significantly higher than the conventional method. The robot-assisted and navigation systems had improved outcomes but were not significantly different in accuracy vs the conventional technique. There was no statistically significant difference concerning safety or clinical outcomes. CONCLUSIONS The accuracy of PSP achieved by robot-assisted technology was the highest, whereas the safety and clinical outcomes of the different methods were comparable. The recent AR technique provided better accuracy compared with navigation and conventional methods. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Kanyakorn Riewruja
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Teerachat Tanasansomboon
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Wicharn Yingsakmongkol
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Vit Kotheeranurak
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Worawat Limthongkul
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Stephen J Kerr
- Research Affair, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Weerasak Singhatanadgige
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
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Vijayan RC, Sheth NM, Wei J, Venkataraman K, Ghanem D, Shafiq B, Siewerdsen JH, Zbijewski W, Li G, Cleary K, Uneri A. Robot-Assisted Reduction of the Ankle Joint via Multi-Body 3D-2D Image Registration. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2024; 6:1591-1602. [PMID: 39991747 PMCID: PMC11845218 DOI: 10.1109/tmrb.2024.3464095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
Purpose Robot-assisted orthopaedic joint reduction offers enhanced precision and control across multiple axes of motion, enabling precise realignment according to predefined plans. However, the high levels of forces encountered may induce unintended anatomical motion and flex mechanical components. To address this, this work presents an approach that uses 2D fluoroscopic imaging to verify and readjust the 3D reduction path by tracking deviations from the planned trajectory. Methods The proposed method involves a 3D-2D registration algorithm using a pair of fluoroscopic images, along with prior models of each body in the radiographic scene. This objective is formulated to couple and constrain multiple object poses (fibula, tibia, talus, and robot end effector), and incorporate novel methods for automatic view and hyperparameter selection to improve robustness. The algorithms were refined through cadaver studies and evaluated in a preclinical trial, employing a robotic system to manipulate a dislocated fibula. Results Studies with cadaveric specimens highlighted the joint-specific formulation's high registration accuracy (Δ x = 0.3 ± 1.5 mm ), further improved with the use of automatic view and hyperparameter selection (Δ x = 0.2 ± 0.8 mm ). Preclinical studies demonstrated a high deviation between the intended and the actual path of the robotic system, which was accurately captured (Δ x < 1 mm ) using the proposed techniques. Conclusions The solution offers to close the loop on image-based guidance of robot-assisted joint reduction by tracking the robot and bones to dynamically correct the course. The approach uses standard clinical images and is expected to lower radiation exposure by providing 3D information and allowing the staff to stay clear of the x-ray beam.
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Affiliation(s)
- R C Vijayan
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - N M Sheth
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - J Wei
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - K Venkataraman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - D Ghanem
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore MD
| | - B Shafiq
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore MD
| | - J H Siewerdsen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston TX
| | - W Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - G Li
- Children's National Hospital, Washington DC
| | - K Cleary
- Children's National Hospital, Washington DC
| | - A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
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Asada T, Subramanian T, Simon CZ, Singh N, Hirase T, Araghi K, Lu AZ, Mai E, Kim YE, Tuma O, Allen MRJ, Kim E, Korsun M, Zhang J, Kwas C, Dowdell J, Iyer S, Qureshi SA. Level-specific comparison of 3D navigated and robotic arm-guided screw placement: an accuracy assessment of 1210 pedicle screws in lumbar surgery. Spine J 2024; 24:1872-1880. [PMID: 38849051 PMCID: PMC11620178 DOI: 10.1016/j.spinee.2024.05.013] [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: 02/26/2024] [Revised: 04/15/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND CONTEXT Robotic spine surgery, utilizing 3D imaging and robotic arms, has been shown to improve the accuracy of pedicle screw placement compared to conventional methods, although its superiority remains under debate. There are few studies evaluating the accuracy of 3D navigated versus robotic-guided screw placement across lumbar levels, addressing anatomical challenges to refine surgical strategies and patient safety. PURPOSE This study aims to investigate the pedicle screw placement accuracy between 3D navigation and robotic arm-guided systems across distinct lumbar levels. STUDY DESIGN A retrospective review of a prospectively collected registry. PATIENT SAMPLE Patients undergoing fusion surgery with pedicle screw placement in the prone position, using either via 3D image navigation only or robotic arm guidance. OUTCOME MEASURE Radiographical screw accuracy was assessed by the postoperative computed tomography (CT) according to the Gertzbein-Robbins classification, particularly focused on accuracy at different lumbar levels. METHODS Accuracy of screw placement in the 3D navigation (Nav group) and robotic arm guidance (Robo group) was compared using Chi-squared test/Fisher's exact test with effect size measured by Cramer's V, both overall and at each specific lumbosacral spinal level. RESULTS A total of 321 patients were included (Nav, 157; Robo, 189) and evaluated 1210 screws (Nav, 651; Robo 559). The Robo group demonstrated significantly higher overall accuracy (98.6 vs 93.9%; p<.001, V=0.25). This difference of no breach screw rate was signified the most at the L3 level (No breach screw: Robo 91.3 vs 57.8%, p<.001, V=0.35) followed by L4 (89.6 vs 64.7%, p<.001, V=0.28), and L5 (92.0 vs 74.5%, p<.001, V=0.22). However, screw accuracy at S1 was not significant between the groups (81.1 vs 72.0%, V=0.10). CONCLUSION This study highlights the enhanced accuracy of robotic arm-guided systems compared to 3D navigation for pedicle screw placement in lumbar fusion surgeries, especially at the L3, L4, and L5 levels. However, at the S1 level, both systems exhibit similar effectiveness, underscoring the importance of understanding each system's specific advantages for optimization of surgical complications.
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Affiliation(s)
- Tomoyuki Asada
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA; University of Tsukuba, Institute of Medicine, Department of Orthopaedic Surgery, Tsukuba, Japan
| | - Tejas Subramanian
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Chad Z Simon
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Nishtha Singh
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Takashi Hirase
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Kasra Araghi
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Amy Z Lu
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Eric Mai
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Yeo Eun Kim
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Olivia Tuma
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Myles R J Allen
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Eric Kim
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | | | - Joshua Zhang
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Cole Kwas
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - James Dowdell
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
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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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Li S, Du J, Huang Y, Hao D, Zhao Z, Chang Z, Zhu J, Wang X, Duan Y, He B. Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine-Edward type IIA (postreduction) hangman fractures. Sci Rep 2023; 13:15934. [PMID: 37741877 PMCID: PMC10517983 DOI: 10.1038/s41598-023-43136-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 09/20/2023] [Indexed: 09/25/2023] Open
Abstract
The objective was to compare the clinical efficacy of percutaneous pedicle screw internal fixation with the aid of the TINAVI orthopaedic surgery robot with that of traditional open surgery for Levine-Edward type IIA (postreduction) hangman fractures and to evaluate the safety and efficacy of the TINAVI robot-assisted orthopaedic surgery procedure. The clinical data of 60 patients with Levine-Edward type IIA (postreduction) hangman fractures treated surgically from June 2015 to February 2022 were analysed retrospectively. Among these patients, 25 were treated with percutaneous pedicle screw fixation under TINAVI (the robot group), and 35 were treated with pedicle screw implantation assisted by a conventional C-arm X-ray machine (the traditional operation group). The pedicle screw placement grade was evaluated according to the Rampersaud scale. The correct rate of pedicle screw placement was calculated. The invasion of adjacent facet joints, VAS score (Visual Analogue Scale), NDI score (Neck Disability Index), SF-36 score (36-Item Short-Form Health Survey questionnaire), EQ-5D score (EuroQol-5 dimensions questionnaire) and operation-related data were recorded, and patients were followed up. All patients were followed up for an average of 15.0 ± 3.4 months. The accuracy of screw placement in the robot group was higher than that in the traditional operation group, while the rates of intraoperative blood loss and invasion of the facet joint were lower and the incision length and length of hospital stay were shorter. On the 3rd day after the operation, the VAS score in the robot group was significantly higher than that in the traditional operation group, but there was no significant difference in the NDI score. On the 3rd day after the operation, the SF-36 and EQ-5 questionnaire scores of the robot group were better than those of the traditional operation group. No complications occurred in any of the patients. Postoperative cervical X-ray showed that the cervical vertebra was stable, and there was no fracture, angle or displacement. Postoperative CT showed that all fractures healed, and the average healing time was 3.4 months. The treatment of Levine-Edward IIA (postrepositioning) hangman fractures with percutaneous pedicle fixation assisted by the TINAVI orthopaedic surgery robot can significantly improve screw placement accuracy with a low rate of invasion of the adjacent facet joint, a short operation time, a low bleeding rate, and high patient satisfaction. Although there are still many disadvantages, it still has good prospects for application.
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Affiliation(s)
- Shuai Li
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
- Medical College, Yan'an University, Yan'an, Shaanxi, China
| | - Jinpeng Du
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Yunfei Huang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Zhigang Zhao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Zhen Chang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Jingwen Zhu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Xiaodong Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - Yongchao Duan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China
| | - BaoRong He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road, Xi'an, 710000, Shaanxi, China.
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Ye S, Chen YZ, Zhong LJ, Yu CZ, Zhang HK, Hong Y. TINAVI robot-assisted one-stage anteroposterior surgery in lateral position for severe thoracolumbar fracture dislocation: A case report. World J Clin Cases 2023; 11:5358-5364. [PMID: 37621589 PMCID: PMC10445060 DOI: 10.12998/wjcc.v11.i22.5358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The combined anterior/posterior approach appears to be capable of reconstructing spinal stability, correcting thoracolumbar deformity, and promoting neural recovery in severe thoracolumbar fracture dislocation. However, this type of operation requires changing the body position during the procedure, resulting in a lengthy operation time. As a universal surgical robot, TINAVI robot has achieved good surgical results in clinical surgery. But to our knowledge, no reports describing TINAVI robot-assisted single lateral position anteroposterior surgery for thoracolumbar fracture dislocation. CASE SUMMARY We describe a case of a 16-year-old female patient with severe thoracolumbar fracture and dislocation underwent surgery assisted by the TINAVI robot. A one-stage combined anterior and posterior operation was performed on a severe thoracolumbar fracture dislocation using the TINAVI robot, and the operation was completed in right lateral position. CONCLUSION The TINAVI robot-assisted one-stage anterior and posterior surgery in right lateral position for severe thoracolumbar fracture and dislocation is both safe and effective.
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Affiliation(s)
- Sen Ye
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Yan-Zhen Chen
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Ling-Jian Zhong
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Chang-Zhang Yu
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Han-Kun Zhang
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Yang Hong
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
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Ye S, Chen YZ, Zhong LJ, Yu CZ, Zhang HK, Hong Y. TINAVI robot-assisted one-stage anteroposterior surgery in lateral position for severe thoracolumbar fracture dislocation: A case report. World J Clin Cases 2023; 11:5352-5358. [DOI: 10.12998/wjcc.v11.i22.5352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The combined anterior/posterior approach appears to be capable of reconstructing spinal stability, correcting thoracolumbar deformity, and promoting neural recovery in severe thoracolumbar fracture dislocation. However, this type of operation requires changing the body position during the procedure, resulting in a lengthy operation time. As a universal surgical robot, TINAVI robot has achieved good surgical results in clinical surgery. But to our knowledge, no reports describing TINAVI robot-assisted single lateral position anteroposterior surgery for thoracolumbar fracture dislocation.
CASE SUMMARY We describe a case of a 16-year-old female patient with severe thoracolumbar fracture and dislocation underwent surgery assisted by the TINAVI robot. A one-stage combined anterior and posterior operation was performed on a severe thoracolumbar fracture dislocation using the TINAVI robot, and the operation was completed in right lateral position.
CONCLUSION The TINAVI robot-assisted one-stage anterior and posterior surgery in right lateral position for severe thoracolumbar fracture and dislocation is both safe and effective.
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Affiliation(s)
- Sen Ye
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Yan-Zhen Chen
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Ling-Jian Zhong
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Chang-Zhang Yu
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Han-Kun Zhang
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Yang Hong
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
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Zhang Q, Han XG, Fan MX, Zhao JW, Lang Z, Jiang JL, He D, Liu B, Tian W. Robotic navigation during spine surgery: an update of literature. Expert Rev Med Devices 2023; 20:427-432. [PMID: 37027325 DOI: 10.1080/17434440.2023.2200932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/05/2023] [Indexed: 04/08/2023]
Abstract
INTRODUCTION The application of robotic navigation during spine surgery has advanced rapidly over the past two decades, especially in the last 5 years. Robotic systems in spine surgery may offer potential advantages for both patients and surgeons. This article serves as an update to our previous review and explores the current status of spine surgery robots in clinical settings. AREAS COVERED We evaluated the literature published from 2020 to 2022 on the outcomes of robotics-assisted spine surgery, including accuracy and its influencing factors, radiation exposure, and follow-up results. EXPERT OPINION The application of robotics in spine surgery has driven spine surgery into a new era of precision treatment through a form of artificial intelligence assistance that compensates for the limitations of human abilities. Modularized robot configurations, intelligent alignment and planning incorporating multimodal images, efficient and simple human - machine interaction, accurate surgical status monitoring, and safe control strategies are the main technical features for the development of orthopedic surgical robots. The use of robotics-assisted decompression, osteotomies, and decision-making warrants further study. Future investigations should focus on patients' needs while continuing to explore in-depth medical - industrial collaborative development innovations that improve the overall utilization of artificial intelligence and sophistication in disease treatment.
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Affiliation(s)
- Qi Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Xiao-Guang Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Ming-Xing Fan
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Jing-Wei Zhao
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Zhao Lang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Ji-Le Jiang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Bo Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
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Chen X, Lei J, Cai S, Peng Y. Design and simulation verification of clamping instrument with active variable stiffness for pelvic fracture reduction. Int J Med Robot 2023; 19:e2473. [PMID: 36259548 DOI: 10.1002/rcs.2473] [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: 06/25/2022] [Revised: 09/19/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND During the robot-assisted pelvic fracture reduction process, the clamping instrument are subjected to the large reduction force from the robot, resulting in inevitable great stress concentration and deformation of the bone pins, affecting the fracture reduction accuracy. METHOD A compact and easily-to-adjust clamping instrument with active variable stiffness is designed. The relationship between the component's elongation and the clamping instrument's deformation and stiffness is derived and calculated. Furthermore, the finite element model of the fixed and the variable stiffness clamping instruments connecting with the injured pelvic musculoskeletal tissue is developed, respectively. RESULTS Applying the same reduction force, the deformation of the clamping instrument with variable stiffness is reduced, especially in the elongated state. Moreover, the new clamping instrument meets the strength requirements and makes a better stress distribution. CONCLUSION The clamping instrument can achieve stiffness adjustment during the reduction process and will be used for improving the surgery accuracy.
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Affiliation(s)
- Xinyi Chen
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Jingtao Lei
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Shenyang Cai
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Ye Peng
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
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11
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Wang C, Fu S, Li X, Wang J, Wu C, Zhang J, Song G, Gu W, Shi Z. Robot-assisted percutaneous screw fixation in the treatment of navicular fracture. Front Surg 2023; 9:1049455. [PMID: 36684335 PMCID: PMC9849596 DOI: 10.3389/fsurg.2022.1049455] [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: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 01/07/2023] Open
Abstract
Background Long recovery time, large scar, postoperative swelling and pain are possible side effects of open reduction internal fixation (ORIF) for tarsal navicular fractures. Early exercise instruction is made possible by the use of an intraoperative robot-assisted percutaneous invasive closed reduction internal fixation. The goal of the trial was to determine whether percutaneous screw internal fixation with robot assistance might be used to treat navicular fractures. Methods 27 patients with navicular fractures had surgical treatment between June 2019 and December 2021. Of those, 20 instances were treated with ORIF, while 7 cases had robot-assisted percutaneous screw internal fixation. At the final follow-up, the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and the visual analogue scale (VAS) score were compared to determine outcomes and function. Results Follow-up was obtained in all 27 patients after surgery, with a mean follow-up time of 21.81 months, ranging from 15 to 29 months . In the 7 instances of robot-assisted group, percutaneous guide wire insertion and screw placement only needed one attempt and the depth and position of the implant were both satisfactory. In the ORIF group, there were two patients who sustained cutaneous nerve injuries. The AOFAS score and the VAS score of the group receiving robot-assisted navigation percutaneous screw fixation were 92.25 ± 2.22 and 0.75 ± 0.25 respectively at the last follow-up, while 82.25 ± 7.15 and 0.50 ± 0.29 were the respective values for the ORIF group. Conclusion Intraoperative robot-assisted percutaneous closed reduction internal fixation for tarsal navicular fractures can accomplish exact localization of fracture site, reduce soft tissue damage and operative time. According to current view, this method offers fewer complications, a faster recovery after surgery, and more patient satisfaction.
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Affiliation(s)
| | | | | | | | | | | | | | - Wenqi Gu
- Correspondence: Zhongmin Shi Wenqi Gu
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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: 20] [Impact Index Per Article: 10.0] [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.
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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
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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: 10] [Impact Index Per Article: 3.3] [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.
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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
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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: 16] [Impact Index Per Article: 5.3] [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.
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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
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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: 0.7] [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]
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