Robot-Assisted Cortical Bone Trajectory Insertion of Pedicle Screws: 2-Dimensional Operative Video

Robot-assisted pedicle screw insertion has been slowly gaining popularity in the spine surgery community. In previous studies, robotics has been shown to increase accuracy and reduce complication rates compared to other navigation technologies, although those studies have been conducted using traditional trajectories for pedicle screw insertion. We present a surgical video in which a robotics system (Mazor X; Mazor Robotics Ltd, Caesarea, Israel) was used to create cortical bone trajectories for the insertion of the screws. The patient in this case is a 52-yr-old woman with severe L4-5 disc herniation requiring a transforaminal interbody fusion with the insertion of pedicle screws. The robotic system's scan-and-plan technique was utilized, in which an intraoperative computed tomography (CT) scan generates a real-time operative plan. Other techniques for inserting pedicle screws using cortical bone trajectories include CT navigation and fluoroscopic guidance. These techniques allow the surgeon to manually direct the screw under precise guidance in multiple planes, although the surgeon is still using all 6 degrees of freedom the human hand provides. With robotic guidance, a pilot hole is drilled, which eliminates 4 of 6 degrees of freedom, which can potentially reduce the risk of misplaced screws. To our knowledge, this is the first video demonstrating pedicle screw insertion through cortical bone trajectories using robotic guidance. Future studies are warranted to compare cortical bone trajectory insertion using different navigation techniques to determine the long-term efficacy of each technique. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary.