scholarly journals Evaluation of robot-guided minimally invasive implantation of 2067 pedicle screws

2017 ◽  
Vol 42 (5) ◽  
pp. E11 ◽  
Author(s):  
Naureen Keric ◽  
Christian Doenitz ◽  
Amer Haj ◽  
Izabela Rachwal-Czyzewicz ◽  
Mirjam Renovanz ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Image Guidance ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Complication Rates ◽  
Intraoperative Radiation ◽  
Invasive Approach ◽  
Placement Accuracy ◽  
Spinal Image

ObjectiveRecent studies have investigated the role of spinal image guidance for pedicle screw placement. Many authors have observed an elevated placement accuracy and overall improvement of outcome measures. This study assessed a bi-institutional experience following introduction of the Renaissance miniature robot for spinal image guidance in Europe.MethodsThe medical records and radiographs of all patients who underwent robot-guided implantation of spinal instrumentation using the novel system (between October 2011 and March 2015 in Mainz and February 2014 and February 2016 in Regensburg) were reviewed to determine the efficacy and safety of the newly introduced robotic system. Screw position accuracy, complications, exposure durations to intraoperative radiation, and reoperation rate were assessed.ResultsOf the 413 surgeries that used robotic guidance, 406 were via a minimally invasive approach. In 7 cases the surgeon switched to conventional screw placement, using a midline approach, due to referencing problems. A total of 2067 screws were implanted using robotic guidance, and 1857 screws were evaluated by postoperative CT. Of the 1857 screws, 1799 (96.9%) were classified as having an acceptable or good position, whereas 38 screws (2%) showed deviations of 3–6 mm and 20 screws (1.1%) had deviations > 6 mm. Nine misplaced screws, implanted in 7 patients, required revision surgery, yielding a screw revision rate of 0.48% of the screws and 7 of 406 (1.7%) of the patients. The mean ± SD per-patient intraoperative fluoroscopy exposure was 114.4 (± 72.5) seconds for 5.1 screws on average and any further procedure required. Perioperative and direct postoperative complications included hemorrhage (2 patients, 0.49%) and wound infections necessitating surgical revision (20 patients, 4.9%).ConclusionsThe hexapod miniature robotic device proved to be a safe and robust instrument in all situations, including those in which patients were treated on an emergency basis. Placement accuracy was high; peri- and early postoperative complication rates were found to be lower than rates published in other series of percutaneous screw placement techniques. Intraoperative radiation exposure was found to be comparable to published values for other minimally invasive and conventional approaches.

scholarly journals A Quantitative Accuracy Assessment of The Use of A Rigid Robotic Arm In Navigated Placement of 726 Pedicle Screws

2021 ◽  
Author(s):  
Carlo Alberto Benech ◽  
Rosa Perez ◽  
Franco Benech ◽  
Torrey Shirk ◽  
Brandon Bucklen
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Accuracy Assessment ◽  
Demographic Data ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Complication Rates ◽  
Pedicle Screw Placement ◽  
Preoperative Ct ◽  
Placement Accuracy

Abstract Background: Traditional minimally invasive fluoroscopy-based techniques for pedicle screw placement utilize guidance, which may require fluoroscopic shots. Computerized tomography (CT) navigation results in more accurate screw placement. Robotic surgery seeks to establish access and trajectory with greater accuracy. Objective: This study evaluated the screw placement accuracy of a robotic platform.Methods: Demographic data, preoperative/postoperative CT scans, and complication rates of 127 patients who underwent lumbosacral pedicle screw placement with minimally invasive navigated robotic guidance using preoperative CT were analyzed. Results: On the GRS scale, 97.9% (711/726) of screws were graded A or B, 1.7% (12/726) of screws graded C, 0.4% (3/726) of screws graded D, and 0% graded E. Average offset from preoperative plan to final screw placement was 1.9 ± 1.5 mm from tip, 2.2 ± 1.4 mm from tail and 2.9 ± 2.3° of angulation.Conclusions: Robotic-assisted surgery utilizing preoperative CT workflow with intraoperative fluoroscopy-based registration improves pedicle screw placement accuracy within a patient’s pedicles.

Percutaneous iliac screw placement: description of a new minimally invasive technique

2008 ◽  
Vol 25 (2) ◽  
pp. E17 ◽  
Author(s):  
Michael Y. Wang ◽  
Steven C. Ludwig ◽  
D. Greg Anderson ◽  
Praveen V. Mummaneni
Keyword(s):  
Minimally Invasive ◽  
Burst Fracture ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Invasive Technique ◽  
Invasive Approach ◽  
Spinal Stabilization ◽  
Future Studies ◽  
The Past ◽  
Iliac Screw

Minimally invasive spinal instrumentation techniques have evolved tremendously over the past decade. Although there have been numerous reports of lumbar instrumentation performed via a percutaneous or minimal incisional route, to date there have been no reports of minimally invasive iliac screw placement. A method was developed for accurate placement of minimally invasive iliac screw placement based on a modification of currently available percutaneous lumbar instrumentation techniques. The method involves fluoroscopically guided insertion of a cannula-based screw system, and this technique was successful applied to treat an L-5 burst fracture with L-4 to iliac spinal stabilization via a minimally invasive approach. This report demonstrates the feasibility of percutaneous iliac screw instrumentation. However, future studies will be needed to validate the safety and efficacy of this approach.

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

2021 ◽  
pp. 1-8
Author(s):  
Przemysław Adamczyk ◽  
Paweł Pobłocki ◽  
Mateusz Kadlubowski ◽  
Adam Ostrowski ◽  
Witold Mikołajczak ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Complication Rate ◽  
Tnm Stage ◽  
Complication Rates ◽  
Open Approach ◽  
Invasive Approach ◽  
Asa Score

<b><i>Purpose:</i></b> This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. <b><i>Methods:</i></b> A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). <b><i>Results:</i></b> The surgical technique was significantly related to the number of complications (<i>p</i> &#x3c; 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (<i>p</i> &#x3c; 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (<i>p</i> &#x3c; 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. <b><i>Conclusions:</i></b> The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

scholarly journals Application of Intraoperative CT-Guided Navigation in Simultaneous Minimally Invasive Anterior and Posterior Surgery for Infectious Spondylitis

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Meng-Huang Wu ◽  
Navneet Kumar Dubey ◽  
Ching-Yu Lee ◽  
Yen-Yao Li ◽  
Chin-Chang Cheng ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screws ◽  
Ct Guided ◽  
Posterior Surgery ◽  
Intraoperative Computed Tomography ◽  
Reactive Protein ◽  
Angle Correction ◽  
Average Operative Time ◽  
Placement Accuracy ◽  
Infectious Spondylitis

This study was aimed at evaluating the safety and efficacy of using intraoperative computed tomography- (iCT-) guided navigation in simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. Nine patients with infectious spondylitis were enrolled in this study. The average operative time was 327.6 min (range, 210–490) and intraoperative blood loss was 407 cc (range, 50–1,200). The average duration of hospital stay was 48.9 days (range, 11–76). Out of a total of 54 pedicle screws employed, 53 screws (98.1%) were placed accurately. A reduced visual analog scale on back pain (from 8.2 to 2.2) and Oswestry disability index (from 67.1% to 25.6%) were found at the 2-year follow-up. All patients had achieved resolution of spinal infection with reduced average erythrocyte sedimentation rate (from 83.9 to 14.1 mm/hr) and average C-reactive protein (from 54.4 to 4.8 mg/dL). Average kyphotic angle correction was 10.5° (range, 8.4°–12.6°) postoperatively and 8.5° (range, 6.9°–10.1°) after 2 years. In conclusion, the current iCT-guided navigation approach has been demonstrated to be an alternative method during simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. It can provide a good intraoperative orientation and visualization of anatomic structures and also a high pedicle screw placement accuracy in patient’s lateral decubitus position.

The accuracy of pedicle screw placement using intraoperative image guidance systems

2014 ◽  
Vol 20 (2) ◽  
pp. 196-203 ◽  
Author(s):  
Alexander Mason ◽  
Renee Paulsen ◽  
Jason M. Babuska ◽  
Sharad Rajpal ◽  
Sigita Burneikiene ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Image Guidance ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Data Sets ◽  
Pedicle Screw Placement ◽  
Fluoroscopic Image ◽  
Fluoroscopic Navigation ◽  
Guidance Systems ◽  
Accuracy Rates

Object Several retrospective studies have demonstrated higher accuracy rates and increased safety for navigated pedicle screw placement than for free-hand techniques; however, the accuracy differences between navigation systems has not been extensively studied. In some instances, 3D fluoroscopic navigation methods have been reported to not be more accurate than 2D navigation methods for pedicle screw placement. The authors of this study endeavored to identify if 3D fluoroscopic navigation methods resulted in a higher placement accuracy of pedicle screws. Methods A systematic analysis was conducted to examine pedicle screw insertion accuracy based on the use of 2D, 3D, and conventional fluoroscopic image guidance systems. A PubMed and MEDLINE database search was conducted to review the published literature that focused on the accuracy of pedicle screw placement using intraoperative, real-time fluoroscopic image guidance in spine fusion surgeries. The pedicle screw accuracy rates were segregated according to spinal level because each spinal region has individual anatomical and morphological variations. Descriptive statistics were used to compare the pedicle screw insertion accuracy rate differences among the navigation methods. Results A total of 30 studies were included in the analysis. The data were abstracted and analyzed for the following groups: 12 data sets that used conventional fluoroscopy, 8 data sets that used 2D fluoroscopic navigation, and 20 data sets that used 3D fluoroscopic navigation. These studies included 1973 patients in whom 9310 pedicle screws were inserted. With conventional fluoroscopy, 2532 of 3719 screws were inserted accurately (68.1% accuracy); with 2D fluoroscopic navigation, 1031 of 1223 screws were inserted accurately (84.3% accuracy); and with 3D fluoroscopic navigation, 4170 of 4368 screws were inserted accurately (95.5% accuracy). The accuracy rates when 3D was compared with 2D fluoroscopic navigation were also consistently higher throughout all individual spinal levels. Conclusions Three-dimensional fluoroscopic image guidance systems demonstrated a significantly higher pedicle screw placement accuracy than conventional fluoroscopy or 2D fluoroscopic image guidance methods.

scholarly journals Radiographic Accuracy of Percutaneous Pedicle Screw Placement in Fluoroscopic- Versus CT Navigation-Guided Lumbar Spine Instrumentation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Guang-Ting Cong ◽  
Avani Vaishnav ◽  
Joseph Barbera ◽  
Hiroshi Kumagai ◽  
James Dowdell ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Intraoperative Computed Tomography ◽  
Percutaneous Pedicle Screw ◽  
Spine Instrumentation ◽  
Surgical Methods

Abstract INTRODUCTION Posterior spinal instrumentation for fusion using intraoperative computed tomography (CT) navigation is gaining traction as an alternative to the conventional two-dimensional fluoroscopic-guided approach to percutaneous pedicle screw placement. However, few studies to date have directly compared outcomes of these 2 minimally invasive instrumentation methods. METHODS A consecutive cohort of patients undergoing primary percutaneous posterior lumbar spine instrumentation for spine fusion was retrospectively reviewed. Revision surgeries or cases converted to open were excluded. Accuracy of screw placement was assessed using a postoperative CT scan with blinding to the surgical methods used. The Gertzbein-Robbins classification was used to grade cortical breach: Grade 0 (<0 mm cortical breach), Grade I (<2 mm), Grade II (2-4 mm), Grade III (4-6 mm), and Grade IV (>6 mm). RESULTS CT navigation was found to significantly improve accuracy of screw placement (P < .022). There was significantly more facet violation of the unfused level in the fluoroscopy group vs the CT group (9% vs 0.5%; P < .0001). There was also a higher proportion of poor screw placement in the fluoroscopy group (10.1% vs 3.6%). No statistical difference was found in the rate of tip breach, inferomedial breach, or lateral breach. Regression analysis showed that fluoroscopy had twice the odds of incurring poor screw placement as compared to CT navigation. CONCLUSION This radiographic study comparing screw placement in minimally invasive fluoroscopy- vs CT navigation-guided lumbar spine instrumentation provides evidence that CT navigation significantly improves accuracy of screw placement, especially in optimizing the screw trajectory so as to avoid facet violation. Long-term follow-up studies should be performed to ascertain whether this difference can contribute to an improvement in clinical outcomes.

scholarly journals Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion

2013 ◽  
Vol 35 (2) ◽  
pp. E7 ◽  
Author(s):  
Pedro S. Silva ◽  
Paulo Pereira ◽  
Pedro Monteiro ◽  
Pedro A. Silva ◽  
Rui Vaz
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Interbody Fusion ◽  
Operative Time ◽  
Pedicle Screws ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Adjacent Level ◽  
Negative Exponential

Object Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has the potential advantage of minimizing soft-tissue damage and reducing recovery time compared to open procedures. A steep learning curve has been described for the technique. The aim of the present study was to define the learning curve that describes the progress of a single surgeon performing the MI-TLIF. Methods One hundred fifty consecutive patients with degenerative lumbar disease who underwent 1- or 2-level MI-TLIF were included in the study. Operative time, corrected operative time per level, and complications were analyzed. The learning curve was assessed using a negative exponential curve-fit regression analysis. Results One hundred ten patients underwent 1-level and 18 patients underwent 2-level MI-TLIF; the remaining 22 underwent a single-level procedure plus an ancillary procedure (decompression at adjacent level, vertebral augmentation through fenestrated pedicle screws, interspinous device at adjacent level). Negative exponential curves appropriately described the relationship between operative time and experience for 1-level surgery and after correction of operative time per level (R2 = 0.65 and 0.57). The median operative time was 140 minutes (interquartile range 120–173 minutes), and a 50% learning milestone was achieved at Case 12; a 90% learning milestone was achieved at Case 39. No patient required transfusion in the perioperative period. The overall complication rate was 12.67% and the most frequent complication was a dural tear (5.32%). Before the 50% and 90% learning milestones, the complication rates were 33% and 20.51%, respectively. Conclusions The MI-TLIF is a reliable and effective option for lumbar arthrodesis. According to the present study, 90% of the learning curve can be achieved at around the 40th case.

scholarly journals Anatomical and radiologic characteristics of isthmus parameters in guiding pedicle screw placement

2018 ◽  
Vol 46 (6) ◽  
pp. 2386-2397 ◽  
Author(s):  
Paerhati Rexiti ◽  
Yakufu Abulizi ◽  
Aikeremujiang Muheremu ◽  
Shuiquan Wang ◽  
Maierdan Maimaiti ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Lumbar Spine Surgery ◽  
X Rays ◽  
Pedicle Screw Placement ◽  
Chinese Han ◽  
Before And After ◽  
Placement Accuracy ◽  
D Value

Objective To study the clinical application of lumbar isthmus parameters in guiding pedicle screw placement. Methods Lumbar isthmus parameters were measured in normal lumbar x-rays and cadaveric specimens from a Chinese Han population. Distance between the medial pedicle border and lateral isthmus border was recorded as a ‘D’ value and was compared between X-rays and cadavers. Orthopaedic surgeons estimated different distances (2–6 mm) and angles (5–20°), and bias ratios between estimated and real values were compared. Orthopaedic residents placed pedicle screws on cadaveric specimens before and after application of the ‘D’ value, and screw placement accuracy was compared. Results Except for L4 vertebrae, significant differences in the ‘D’ value were found between 25 cadaveric specimens and x-ray films from 120 patients. Distances and angles estimated by 40 surgeons were significantly different from all real values, except 2 mm distance. Accuracy of pedicle screw placement by six orthopaedic residents was significantly improved by applying the ‘D’ value. Conclusions Surgeon estimates of distance were more accurate than angle estimates. Addition of a ‘D’ value to conventional parameters may significantly improve pedicle screw placement accuracy in lumbar spine surgery.

Placement of thoracic transvertebral pedicle screws using 3D image guidance

2013 ◽  
Vol 18 (5) ◽  
pp. 479-483 ◽  
Author(s):  
Eric W. Nottmeier ◽  
Stephen M. Pirris
Keyword(s):  
Pedicle Screw ◽  
Image Guidance ◽  
Pedicle Screws ◽  
Guidance System ◽  
Ct Scans ◽  
Screw Placement ◽  
Clinical Consequence ◽  
3D Image ◽  
Cortical Layers ◽  
Disc Space

Object Transvertebral pedicle screws have successfully been used in the treatment of high-grade L5–S1 spondylolisthesis. An advantage of transvertebral pedicle screws is the purchase of multiple cortical layers across 2 vertebrae, thereby increasing the stability of the construct. At the lumbosacral junction, transvertebral pedicle screws have been shown to be biomechanically superior to pedicle screws placed in the standard fashion. The use of transvertebral pedicle screws at spinal levels other than L5–S1 has not been reported in the literature. The authors describe their technique of transvertebral pedicle screw placement in the thoracic spine using 3D image guidance. Methods Twelve patients undergoing cervicothoracic or thoracolumbar fusion had 41 thoracic transvertebral pedicle screws placed across 26 spinal levels using this technique. Indications for placement of thoracic transvertebral pedicle screws in earlier cases included osteoporosis and pedicle screw salvage. However, in subsequent cases screws were placed in patients undergoing multilevel thoracolumbar fusion without osteoporosis, particularly near the top of the construct. Image guidance in this study was accomplished using the Medtronic StealthStation S7 image guidance system used in conjunction with the O-arm. All patients were slated to undergo postoperative CT scanning at approximately 4–6 months for fusion assessment, which also allowed for grading of the transvertebral pedicle screws. Results No thoracic transvertebral pedicle screw placed in this study had to be replaced or repositioned after intraoperative review of the cone beam CT scans. Review of the postoperative CT scans revealed all transvertebral screws to be across the superior disc space with the tips in the superior vertebral body. Six pedicle screws were placed using the in-out-in technique in patients with narrow pedicles, leaving 35 screws that underwent breach analysis. No pedicle breach was noted in 34 of 35 screws. A Grade 1 (< 2 mm) medial breach was noted in 1 screw without clinical consequence. Solid fusion was observed across 25 of 26 spinal levels that underwent transvertebral screw placement including 7 spinal levels located at the top of a multilevel construct. Conclusions This report describes the authors' initial in vivo experience with the 3D image-guided placement of 41 thoracic transvertebral pedicle screws. Advantages of thoracic transvertebral screws include the purchase of 2 vertebral segments across multiple cortical layers. A high fusion rate was observed across spinal levels in which transvertebral screws were placed. A formal biomechanical study is needed to assess the biomechanical advantages of this technique and is currently being planned.

scholarly journals Minimally invasive transforaminal lumbar interbody fusion with percutaneous navigated guidewireless lumbosacral pedicle screw fixation

2016 ◽  
Vol 41 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
Kevin S. Chen ◽  
Paul Park
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Pedicle Screw Fixation ◽  
Screw Placement ◽  
Foraminal Stenosis ◽  
Invasive Approach ◽  
Percutaneous Pedicle Screw ◽  
Key Steps

This video details the minimally invasive approach for treatment of a symptomatic Grade II lytic spondylolisthesis with high-grade foraminal stenosis. In this procedure, the use of a navigated, guidewireless technique for percutaneous pedicle screw placement at the lumbosacral junction is highlighted following initial decompression and transforaminal interbody fusion. Key steps of the procedure are delineated that include positioning, exposure, technique for interbody fusion, intraoperative image acquisition, and use of a concise 2-step process for navigated screw placement without using guidewires.The video can be found here: https://youtu.be/2u6H4Pc_8To.

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