scholarly journals Usability of Graphical Visualizations on a Tool-Mounted Interface for Spine Surgery

2021 ◽  
Vol 7 (8) ◽  
pp. 159
Author(s):  
Laura Schütz ◽  
Caroline Brendle ◽  
Javier Esteban ◽  
Sandro M. Krieg ◽  
Ulrich Eck ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Navigation Systems ◽  
Pedicle Screw Placement ◽  
Spinal Fusion Surgery ◽  
Positive Effects ◽  
Mental Demand ◽  
Spinal Navigation ◽  
New Research ◽  
Navigation Information

Screw placement in the correct angular trajectory is one of the most intricate tasks during spinal fusion surgery. Due to the crucial role of pedicle screw placement for the outcome of the operation, spinal navigation has been introduced into the clinical routine. Despite its positive effects on the precision and safety of the surgical procedure, local separation of the navigation information and the surgical site, combined with intricate visualizations, limit the benefits of the navigation systems. Instead of a tech-driven design, a focus on usability is required in new research approaches to enable advanced and effective visualizations. This work presents a new tool-mounted interface (TMI) for pedicle screw placement. By fixing a TMI onto the surgical instrument, physical de-coupling of the anatomical target and navigation information is resolved. A total of 18 surgeons participated in a usability study comparing the TMI to the state-of-the-art visualization on an external screen. With the usage of the TMI, significant improvements in system usability (Kruskal–Wallis test p < 0.05) were achieved. A significant reduction in mental demand and overall cognitive load, measured using a NASA-TLX (p < 0.05), were observed. Moreover, a general improvement in performance was shown by means of the surgical task time (one-way ANOVA p < 0.001).

scholarly journals Four Year Experience of Robot-Assisted Pedicle Screw Placement: An Australian Prospective Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jordan Cory ◽  
Mohammed A Awad ◽  
Richard G Bittar
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Intraoperative Radiation ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery

Abstract INTRODUCTION Robot-assisted surgery has emerged as an innovative and minimally-invasive technique, touted as superior to the traditional free-hand technique of pedicle screw fixation in spinal fusion surgery. Complications of misplaced pedicle screws include inadequate fixation and surgical failure requiring revision, neural injury, cerebrospinal fluid (CSF) leak, vascular injury, and facet joint trauma with sequela of adjacent segment disease. Literature reports an incidence of pedicle screw misplacement in up to 10% with free-hand technique. Robot-assisted surgery has reported superiority with increased accuracy of pedicle screw placement and reduced complication rates. This prospective multi-institutional single cohort analysis reports the outcomes in robot-assisted spinal fusion surgery in Melbourne, Australia over 4 yr. METHODS Data was prospectively collected from 2015 to 2019 from robot-assisted spinal surgeries performed by 2 surgeons across 2 institutions. Postoperative spinal computed tomography (CT) scan was compared to preoperative CT based planning to determine the accuracy of pedicle screw placement to 0.1 mm. Accurate pedicle screw placement was defined as within 2.0 mm from the target. Intraoperative radiation exposure time, operative time and length of hospital stay were also collected. RESULTS The total number of cases was 164 and the total number of screws placed was 744. Accurate pedicle screw placement was 98.65%. Average intraoperative radiation exposure time was 9.9 s. Average operative time for single-level surgery was 74 min. The average length of hospital stay was 2.4 d. CONCLUSION The authors conclude that robot-assisted pedicle screw placement is a safe and highly accurate adjunct to spinal surgery. While robot-assisted spinal surgery significantly improves patient outcomes with reduced patient morbidity and revision rates, it has limitations in primary capital expenditure, consumable costs and, in training and accreditation. It is the authors’ opinion that the robot-assisted spinal surgery technique requires nuanced patient selection and expertise in the traditional free-hand method is still essential in the event of technological failure.

scholarly journals Intraoperative image-guided spinal navigation: technical pitfalls and their avoidance

2014 ◽  
Vol 36 (3) ◽  
pp. E3 ◽  
Author(s):  
Gazanfar Rahmathulla ◽  
Eric W. Nottmeier ◽  
Stephen M. Pirris ◽  
H. Gordon Deen ◽  
Mark A. Pichelmann
Keyword(s):  
Pedicle Screw ◽  
3D Imaging ◽  
Image Guidance ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Navigation Systems ◽  
Spinal Fixation ◽  
Pedicle Screw Placement ◽  
Screw Insertion ◽  
Spinal Navigation

Spinal instrumentation has made significant advances in the last two decades, with transpedicular constructs now widely used in spinal fixation. Pedicle screw constructs are routinely used in thoracolumbar-instrumented fusions, and in recent years, the cervical spine as well. Three-column fixations with pedicle screws provide the most rigid form of posterior stabilization. Surgical landmarks and fluoroscopy have been used routinely for pedicle screw insertion, but a number of studies reveal inaccuracies in placement using these conventional techniques (ranging from 10% to 50%). The ability to combine 3D imaging with intraoperative navigation systems has improved the accuracy and safety of pedicle screw placement, especially in more complex spinal deformities. However, in the authors' experience with image guidance in more than 1500 cases, several potential pitfalls have been identified while using intraoperative spinal navigation that could lead to suboptimal results. This article summarizes the authors' experience with these various pitfalls using spinal navigation, and gives practical tips on their avoidance and management.

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