Quad S2-Alar-Iliac Screw Fixation via Navigated Spinal Robotics With Software Planning: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (5) ◽  
pp. E523-E523 ◽  
Author(s):  
Martin H Pham ◽  
Luis Daniel Diaz-Aguilar ◽  
Bradley H King ◽  
Joseph A Osorio ◽  
Ronald A Lehman
Keyword(s):  
Spine Surgery ◽  
Surgical Procedure ◽  
Screw Fixation ◽  
Spinal Instrumentation ◽  
Robotic Assistance ◽  
Patient Consent ◽  
Iliac Screws ◽  
Iliac Screw ◽  
Robotic Platforms

Abstract The use of robotic guidance for spinal instrumentation has become promising for its ability to offer the advantages of precision, accuracy, and reproducibility. However, utilization and adoption of robotic platforms for spine surgery remain limited especially in comparison to other surgical fields. We present here a case of a 71-yr-old man with a prior T4-pelvis long-segment fusion who presented with distal sacro-iliac instrumentation loosening with pseudarthrosis. He subsequently underwent construct revision with quad (bilateral dual) S2-alar-iliac screw fixation with navigated spinal robotic assistance (Mazor X Stealth Edition, Medtronic Sofamor Danek, Medtronic Inc, Dublin, Ireland). To our knowledge, this is the first video demonstrating the preoperative software planning and intraoperative workflow for placing quad S2-alar-iliac screws with navigated spinal robotic guidance using the Mazor X Stealth Edition.  There is no identifying information in this video. Patient consent was obtained for the surgical procedure and for publishing of the material included in the video.

Robotic-Assisted Endoscopic Laminotomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Yingda Li ◽  
Michael Y Wang
Keyword(s):  
Spine Surgery ◽  
Human Error ◽  
Robotic Assistance ◽  
The Novel ◽  
Robotic Assisted ◽  
Accuracy And Precision ◽  
Surgical Ergonomics ◽  
Patient Consent ◽  
Potential Synergy ◽  
And Robotics

Abstract Endoscopy and robotics represent two emerging technologies within the field of spine surgery, the former an ultra-MIS approach minimizing the perioperative footprint and the latter leveraging accuracy and precision. Herein, we present the novel incorporation of robotic assistance into endoscopic laminotomy, applied to a 27-yr-old female with a large caudally migrated L4-5 disc herniation. Patient consent was obtained. Robotic guidance was deployed in (1) planning of a focussed laminotomy map, pivoting on a single skin entry point; (2) percutaneous targeting of the interlaminar window; and (3) execution of precision drilling, controlled for depth. Through this case, we illustrated the potential synergy between these 2 technologies in achieving precise bony removal tailored to the patient's unique pathoanatomy while simultaneously introducing safety mechanisms against human error and improving surgical ergonomics.1,2 The physicians consented to the publication of their images.

Robotic-Assisted Spine Surgery Using the Mazor XTM System: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. E123-E123 ◽  
Author(s):  
Lee A Tan ◽  
Ronald A Lehman
Keyword(s):  
Spine Surgery ◽  
Screw Placement ◽  
Illustrative Case ◽  
Robotic Assistance ◽  
Pedicle Screw Placement ◽  
Robotic Assisted ◽  
Patient Consent ◽  
System 2 ◽  
Screw Malposition ◽  
Lumbar Pedicle

Abstract We demonstrate the setup and workflow of performing robotic spine surgery using the Mazor XTM system (MAZOR Robotics Inc, Orlando, Florida) in this video. An illustrative case was presented, including detailed steps for S2AI screw and lumbar pedicle screw placement using robotic assistance. A step-by-step narration is provided along with discussion of surgical nuances. Robotic spine surgery can be a safe and efficient method for screw placement, which can potentially reduce the risk of screw malposition. Spine surgeons should be familiar with this technology and keep this technique in their armamentarium. There is no identifying information in this video. A patient consent was obtained for publishing of the material included in the video.

Low rates of complications after spinopelvic fixation with iliac screws in 260 adult patients with a minimum 2-year follow-up

2019 ◽  
Vol 30 (5) ◽  
pp. 635-643 ◽  
Author(s):  
James H. Nguyen ◽  
Thomas J. Buell ◽  
Tony R. Wang ◽  
Jeffrey P. Mullin ◽  
Marcus D. Mazur ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Wound Dehiscence ◽  
Adult Patients ◽  
Complication Rates ◽  
Related Complication ◽  
Screw Head ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Iliac Screw

OBJECTIVERecent literature describing complications associated with spinopelvic fixation with iliac screws in adult patients has been limited but has suggested high complication rates. The authors’ objective was to report their experience with iliac screw fixation in a large series of patients with a 2-year minimum follow-up.METHODSOf 327 adult patients undergoing spinopelvic fixation with iliac screws at the authors’ institution between 2010 and 2015, 260 met the study inclusion criteria (age ≥ 18 years, first-time iliac screw placement, and 2-year minimum follow-up). Patients with active spinal infection were excluded. All iliac screws were placed via a posterior midline approach using fluoroscopic guidance. Iliac screw heads were deeply recessed into the posterior superior iliac spine. Clinical and radiographic data were obtained and analyzed.RESULTSTwenty patients (7.7%) had iliac screw–related complication, which included fracture (12, 4.6%) and/or screw loosening (9, 3.5%). No patients had iliac screw head prominence that required revision surgery or resulted in pain, wound dehiscence, or poor cosmesis. Eleven patients (4.2%) had rod or connector fracture below S1. Overall, 23 patients (8.8%) had L5–S1 pseudarthrosis. Four patients (1.5%) had fracture of the S1 screw. Seven patients (2.7%) had wound dehiscence (unrelated to the iliac screw head) or infection. The rate of reoperation (excluding proximal junctional kyphosis) was 17.7%. On univariate analysis, an iliac screw–related complication rate was significantly associated with revision fusion (70.0% vs 41.2%, p = 0.013), a greater number of instrumented vertebrae (mean 12.6 vs 10.3, p = 0.014), and greater postoperative pelvic tilt (mean 27.7° vs 23.2°, p = 0.04). Lumbosacral junction–related complications were associated with a greater mean number of instrumented vertebrae (12.6 vs 10.3, p = 0.014). Reoperation was associated with a younger mean age at surgery (61.8 vs 65.8 years, p = 0.014), a greater mean number of instrumented vertebrae (12.2 vs 10.2, p = 0.001), and longer clinical and radiological mean follow-up duration (55.8 vs 44.5 months, p < 0.001; 55.8 vs 44.6 months, p < 0.001, respectively). On multivariate analysis, reoperation was associated with longer clinical follow-up (p < 0.001).CONCLUSIONSPrevious studies on iliac screw fixation have reported very high rates of complications and reoperation (as high as 53.6%). In this large, single-center series of adult patients, iliac screws were an effective method of spinopelvic fixation that had high rates of lumbosacral fusion and far lower complication rates than previously reported. Collectively, these findings argue that iliac screw fixation should remain a favored technique for spinopelvic fixation.

Navigated Spinal Robotics in Minimally Invasive Spine Surgery, With Preoperative and Intraoperative Workflows: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E422-E422
Author(s):  
Martin H Pham ◽  
Joseph A Osorio ◽  
Ronald A Lehman
Keyword(s):  
Minimally Invasive ◽  
Ct Scan ◽  
Spine Surgery ◽  
Degenerative Spondylolisthesis ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Minimally Invasive Spine Surgery ◽  
Patient Consent ◽  
Minimally Invasive Spine

Abstract The use of robotic guidance for spinal instrumentation has become promising for its ability to offer the advantages of precision, accuracy, and reproducibility. However, the utilization and adoption of robotic platforms for spine surgery remain limited, especially in comparison to other surgical fields. We present here a case of a 52-yr-old man with a grade 1 L4-5 degenerative spondylolisthesis causing severe claudication and radiculopathy who subsequently underwent a minimally invasive L4-5 transforaminal lumbar interbody fusion with navigated spinal robotic assistance (Mazor X Stealth Edition, Mazor Robotics Ltd, Caesarea, Israel). This platform allows for planning and registration via (1) a preoperative thin-cut computed tomography (CT) scan, or (2) an intraoperative CT “scan-and-plan” method. We show here the preoperative CT method that we use in the majority of our patients. To our knowledge, this is the first video demonstrating the preoperative software and intraoperative surgical registration and instrument workflow of navigated spinal robotic guidance using the Mazor X Stealth Edition for the insertion of pedicle screws in a minimally invasive spine surgery procedure. There is no identifying information in this video. Patient consent was obtained for the surgical procedure and for publishing of the material included in the video.

scholarly journals Unilateral versus bilateral iliac screws for spinopelvic fixation: are two screws better than one?

2014 ◽  
Vol 36 (5) ◽  
pp. E10 ◽  
Author(s):  
Rajiv Saigal ◽  
Darryl Lau ◽  
Rishi Wadhwa ◽  
Hai Le ◽  
Morsi Khashan ◽  
...  
Keyword(s):  
Postoperative Infection ◽  
Screw Fixation ◽  
Insufficiency Fractures ◽  
Single Institution ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Iliac Screw ◽  
Sacral Insufficiency Fractures ◽  
The Mean

Object Long-segment spinal instrumentation ending at the sacrum places substantial biomechanical stress on sacral screws. Iliac (pelvic) screws relieve some of this stress by supplementing the caudal fixation. It remains an open question whether there is any clinically significant difference in sacropelvic fixation with bilateral versus unilateral iliac screws. The primary purpose of this study was to compare clinical and radiographic complications in the use of bilateral versus unilateral iliac screw fixation. Methods The authors retrospectively reviewed 102 consecutive spinal fixation cases that extended to the pelvis at a single institution (University of California, San Francisco) in the period from 2005 to 2012 performed by the senior authors. Charts were reviewed for the following complications: reoperation, L5–S1 pseudarthrosis, sacral insufficiency fracture, hardware prominence, iliac screw loosening, and infection. The t-test, Pearson chi-square test, and Fisher exact test were used to determine statistical significance. Results The mean follow-up was 31 months. Thirty cases were excluded: 12 for inadequate follow-up, 15 for lack of L5–S1 interbody fusion, and 3 for preoperative osteomyelitis. The mean age among the 72 remaining cases was 62 years (range 39–79 years). Forty-six patients underwent unilateral and 26 bilateral iliac screw fixation. Forty-one percent (n = 19) of the unilateral cases and 50% (n = 13) of the bilateral cases were treated with reoperation (p = 0.48). In addition, 13% (n = 6) of the unilateral and 19% (n = 5) of the bilateral cases developed L5–S1 pseudarthrosis (p = 0.51). There were no sacral insufficiency fractures. Thirteen percent (n = 6) of the unilateral and 7.7% (n = 2) of the bilateral cases developed postoperative infection (p = 0.70). Conclusions In a retrospective single-institution study, single versus dual pelvic screws led to comparable rates of reoperation, iliac screw removal, postoperative infection, pseudarthrosis, and sacral insufficiency fractures. For spinopelvic fixation, placing bilateral (vs unilateral) pelvic screws produced no added clinical benefit in most cases.

scholarly journals Innovative sacropelvic fixation using iliac screws and triangular titanium implants

2021 ◽  
Author(s):  
Matteo Panico ◽  
Ruchi D. Chande ◽  
Derek P. Lindsey ◽  
Ali Mesiwala ◽  
Tomaso Maria Tobia Villa ◽  
...  
Keyword(s):  
Protective Effect ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Titanium Implants ◽  
Posterior Fixation ◽  
Sacropelvic Fixation ◽  
Iliac Screws ◽  
Iliac Screw ◽  
The Stability ◽  
Severe Spinal Deformities

Abstract Purpose Sacropelvic fixation is frequently used in combination with thoracolumbar instrumentation for the correction of severe spinal deformities. The purpose of this study was to explore the effects of the triangular titanium implants on the iliac screw fixation. Our hypothesis was that the use of triangular titanium implants can increase the stability of the iliac screw fixation. Methods Three T10-pelvis instrumented models were created: pedicle screws and rods in T10-S1, and bilateral iliac screws (IL); posterior fixation and bilateral iliac screws and triangular implants inserted bilaterally in a sacro-alar-iliac trajectory (IL-Tri-SAI); posterior fixation and bilateral iliac screws and two bilateral triangular titanium implants inserted in a lateral trajectory (IL-Tri-Lat). Outputs of these models, such as hardware stresses, were compared against a model with pedicle screws and rods in T10-S1 (PED). Results Sacropelvic fixation decreased the L5-S1 motion by 75–90%. The motion of the SIJ was reduced by 55–80% after iliac fixation; the addition of triangular titanium implants further reduced it. IL, IL-Tri-SAI and IL-Tri-Lat demonstrated lower S1 pedicle stresses with respect to PED. Triangular implants had a protective effect on the iliac screw stresses. Conclusion Sacropelvic fixation decreased L5-S1 range of motion suggesting increased stability of the joint. The combination of triangular titanium implants and iliac screws reduced the residual flexibility of the sacroiliac joint, and resulted in a protective effect on the S1 pedicle screws and iliac screws themselves. Clinical studies may be performed to demonstrate applicability of these FEA results to patient outcomes.

scholarly journals Navigated iliac screw placement may reduce radiation and OR time in lumbopelvic fixation of unstable complex sacral fractures

2021 ◽  
Author(s):  
M. F. Hoffmann ◽  
E. Yilmaz ◽  
D. C. Norvel ◽  
T. A. Schildhauer
Keyword(s):  
Radiation Exposure ◽  
Operative Time ◽  
Pelvic Ring ◽  
Screw Placement ◽  
Fluoroscopy Time ◽  
Complication Rates ◽  
Lumbopelvic Fixation ◽  
Navigation Group ◽  
Iliac Screws ◽  
Iliac Screw

Abstract Purpose Instability of the posterior pelvic ring may be stabilized by lumbopelvic fixation. The optimal osseous corridor for iliac screw placement from the posterior superior iliac spine to the anterior inferior iliac spine requires multiple ap- and lateral-views with additional obturator-outlet and -inlet views. The purpose of this study was to determine if navigated iliac screw placement for lumbopelvic fixation influences surgical time, fluoroscopy time, radiation exposure, and complication rates. Methods Bilateral lumbopelvic fixation was performed in 63 patients. Implants were inserted as previously described by Schildhauer. A passive optoelectronic navigation system with surface matching on L4 was utilized for navigated iliac screw placement. To compare groups, demographics were assessed. Operative time, fluoroscopic time, and radiation were delineated. Results Conventional fluoroscopic imaging for lumbopelvic fixation was performed in 32 patients and 31 patients underwent the procedure with navigated iliac screw placement. No differences were found between the groups regarding demographics, comorbidities, or additional surgical procedures. Utilization of navigation led to fluoroscopy time reduction of more than 50% (3.2 vs. 8.6 min.; p < 0.001) resulting in reduced radiation (2004.5 vs. 5130.8 Gy*cm2; p < 0.001). Operative time was reduced in the navigation group (176.7 vs. 227.4 min; p = 0.002) despite the necessity of additional surface referencing. Conclusion For iliac screws, identifying the correct entry point and angle of implantation requires detailed anatomic knowledge and multiple radiographic views. In our study, additional navigation reduced operative time and fluoroscopy time resulting in a significant reduction of radiation exposure for patients and OR personnel.

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