A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement

Summary

This article presents a standardized surgical technique for robotic-assisted pedicle screw placement by using robotic-assisted navigational systems. We present a step-by-step protocol and describe the workflow and precautions of this procedure.

Abstract

Pedicle screw implantation has excellent treatment effects and is often used by surgeons in spinal fusion surgery. However, due to the complexity of human body anatomy, this surgical procedure is difficult and challenging, especially in minimally invasive surgery or patients with congenital anomalies and kyphoscoliosis deformity. In addition to the abovementioned factors, the surgical experience and technique of the surgeon also affect the recovery rates and complications of the patients after the surgical operation. Therefore, accurately performing pedicle screw implantation has is a constant topic of common concern for surgeons and patients. In recent years, with the technological development, robot-assisted navigation systems have gradually become adopted. These robot-assisted navigation systems provide surgeons with complete preoperative planning before surgery. The system provides 3D reconstructed images of each vertebra, allowing surgeons to understand the patient's physiological characteristics more quickly. It also provides 2D images of sagittal, coronal, axial and oblique planes so that surgeons can accurately perform pedicle screw placement plan.

Previous studies have demonstrated the effectiveness of robot-assisted navigation systems for pedicle screw implantation procedures, including accuracy and safety assessments. This step-by-step protocol aims to outline a standardized surgical technique note for robotic-assisted pedicle screw placement.

Introduction

In the field of spinal surgery, spinal fusion surgery is a fundamental surgical procedure, especially posterior pedicle screw fixation, which can provide three-column support of the vertebrae and enhance the strength of biomechanics; thus, it has become one of the most commonly used surgical procedures¹. In many early studies, the clinical effect of posterior pedicle screw implantation has been confirmed, and it has been widely used in surgery for many different spinal disorders, such as degenerative, traumatic, and complicated spinal conditions².

However, although the posterior lumbar spinal ....

Protocol

All procedures followed were in accordance with the ethical standards of the National Taiwan University Hospital (NTUH) Research Ethics Committee (REC) and the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent must be obtained from all patients if further clinical trial is prepared.

NOTE: The anesthesia procedure can be categorized into three steps: pre-operative evaluation of the patient, intraoperative management, and postoperative management. During pre-operative evaluation, all patient data, including the thorough history and physical examination, should be collected and the staff should recognize pat....

Results

The safety and accuracy of robotic-assisted pedicle screw placements have been addressed in several studies^6,11. We match the vertebrae with pre-operative planning images under an optical tracking system in the proposed method. After determining the planned surgical path, this information was transferred to the handpiece through the handpiece control unit. The navigation system integrates the tracking information and displays it on the monitor during the surgery........

Discussion

Since 1990, there have been rapid developments in surgical applications involving the use of robots. The available robotic technologies have been optimized, resulting in improved accuracy, overcoming the tremor in human hands, and reduced matching and registration times of navigation systems¹⁵. The benefits of surgical robot assistance include: (1) immediate standardization without lengthy learning processes; (2) surgeons can precisely follow the pre-operative plan, which is superimposed on a CT-b.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Dynamic reference frames	POINT
FF tool kit: 1.Connecting Rod 2.Combination clamps 3.Multi-pin clamps 4.Schanz screw 5.Spinous process clamp 6.Open wrench 7.Hexagonal wrench	POINT
Handpiece	POINT
Handpiece holder	POINT
Handpiece stand	POINT
K-pin	POINT
Optical tracker	NDI
Passive spheres	NDI
Probe	POINT
Sterile box	POINT
Sterile drape	POINT
Trocar	POINT
Workstation cart	POINT