A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement
May 11th, 2020
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.
This robot-assisted navigation system is very effective, accurate, and safe. It provides a friendly user interface and automatically compensated handpiece for pedicle screw replacement. The point handpiece of this system has a parallel platform architecture, which has the advantages of a strong load capacity, fast positioning speed, portability, small footprint, and high curvability.
This system can be used to perform minimally invasive surgeries, complicated kyphoid scoliosis deformities and other challenging cases. We plan to use the Robotics system in other surgical procedures such as nerve decompression. In contrast to a traditional surgical methods, this system uses a unique technology that allows visualization of the surgical goals and operation steps within the application interface.
Demonstrating the procedure with me will be Chin-Wei Chen and Xiu-Yun Xiao, engineers from Point Robotics. After anesthesia and draping, place one percutaneous wire with a ply of 1.5 millimeters on the posterior iliac crest to anchor the fiducial frame to the iliac bone of the saw bone and check the entry point under fluoroscopy. Mark the entry point with ink.
Use a power drill set to 1, 000 revolutions per minute to insert the first percutaneous pin into the patient's posterior iliac crest. Use the pin to anchor fiducial frame and adjust the frame until it is recognized by the optical tracking camera. When the frame is in position, use a screwdriver to fix the frame to the pin and use the drill to insert the second percutaneous pin, further securing the frame with the second pin.
Mark the surgical field with ink and use a surgical scalpel to make a skin incision along the mark. Then, use a screwdriver to fix the frame to the spinal process of interest and have the surgeon confirm that the frame has been firmly anchored. For spatial labeling and registration, enter the dynamic reference frame monitoring interface to the Point Spine Navigation System software with multiple planar views.
All of the dynamic reference frames should be inside the vision area of the optical tracking system. When the dynamic reference frame vector arrow is displayed, the tracker has been stably recognized by the tracking system. To ensure a correct registration, select at least four non-coplanar feature points on the patient's pre-operative 3D reconstruction CT images.
Use the tip of the probe to keep in contact with the first feature point within the actual surgical area. Then press Probe Selection'to confirm the access point. When all of the feature points have been confirmed, press Calculation'The system will calculate the result of the landmark registration and present it in the software interface.
When the acceptance criteria for the registration accuracy meets the needs of the clinical indications, use the probe tip. Continuously contact any point on the bone surface in the actual surgical area and press the Probe Selection'button to confirm the access points. When at least 50 pic points have been confirmed, press Calculation'The system will calculate the surface matching result and present it on the software interface.
Once the registration result has been accepted, use the probe to select the obvious anatomical landmarks of the actual surgical area for confirmation. To assemble the robot, angle the handpiece in space so that the two circles representing the angle of the handpiece coincide in the software interface. Then, horizontally and vertically adjust the position of the handpiece, so that the dots representing the position of the handpiece in the software interface are aligned with the entry points of the planned path.
We recommend becoming familiar with the first person orientation of the user interface and the movement we have here of the handheld robot before attempting a surgery. To prepare the pedicle, activate the drill function of the handpiece and drill the instruments mounted on the front end along the planned path. Use the C-arm to confirm the position of the K-pin and the trocar and use the anterior/posterior view to determine whether the instrument is located in the oval area formed by the pedicle in the perspective image.
Then, under the lateral view, determine whether the instrument is within the range of the pedicle and the vertebrae. When the K-pin and trocar positions are appropriate for the procedure, replace them with guide wires and insert the pedicle screws through the guide wires. In a previous study, a low-overall screw malposition rate of 1.7%from a total of 59 screws placed on 34 seen vertebrae through the Point Spine Navigation System was demonstrated.
No spinal canal perforations or injuries to any other major vessels were observed and all of the pedicle screws were positioned within the safe zone. The robot can, not only drill, but also perform even soft tissue manipulations because of the high accuracy of robot, many surgical procedures can be performed safely. Our team is currently focusing on making the user learning curve easier and providing a supporting arm to reduce the weight of the handpiece.
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Overview
This article presents a standardized surgical technique for robotic-assisted pedicle screw placement using robotic-assisted navigational systems. The system is effective, accurate, and safe, providing a user-friendly interface for surgeons.
Key Study Components
Area of Science
- Robotic-assisted surgery
- Minimally invasive techniques
- Orthopedic surgery
Background
- Robotic-assisted navigation systems enhance surgical precision.
- They are designed for complex surgical procedures.
- Traditional methods often lack the visualization capabilities of robotic systems.
- This technology aims to improve patient outcomes in challenging cases.
Purpose of Study
- To present a step-by-step protocol for pedicle screw placement.
- To describe the workflow and precautions of the procedure.
- To demonstrate the advantages of robotic systems in surgery.
Methods Used
- Utilization of a robotic-assisted navigation system.
- Implementation of a user-friendly interface for surgeons.
- Application of a parallel platform architecture for the handpiece.
- Evaluation of the system's effectiveness in various surgical scenarios.
Main Results
- The robotic system offers strong load capacity and fast positioning.
- It is suitable for minimally invasive surgeries and complex deformities.
- The system allows for visualization of surgical goals during procedures.
- Plans to expand its use to other surgical applications are underway.
Conclusions
- Robotic-assisted navigation enhances surgical accuracy and safety.
- This technique can improve outcomes in challenging surgical cases.
- Future applications may include additional surgical procedures.
Frequently Asked Questions
Executive Industry Relevance
Robotic-assisted navigation systems address critical challenges in orthopedic surgery by enhancing precision and safety in pedicle screw placement, a procedure with significant implications for spinal fusion outcomes. The technology supports predictive confidence in surgical planning and execution, particularly for complex anatomies and minimally invasive approaches, reducing variability associated with surgeon experience. This positions the system as a valuable tool for de-risking high-impact procedures in preclinical and translational research settings where anatomical fidelity and procedural reproducibility are paramount.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Scientific Value: Enables precise anatomical targeting in preclinical spinal models, supporting hypothesis testing of biomechanical interventions.
- Operational Value: Provides standardized, reproducible screw placement across multiple test subjects, reducing inter-operator variability in efficacy studies.
Screening & Assay Development
- Scientific Value: Facilitates consistent delivery of therapeutic agents or devices to verified spinal targets, improving assay reliability in spinal pathology models.
- Operational Value: Supports high-fidelity surgical intervention as a controlled variable in preclinical screening workflows.
Translational & Preclinical Research
- Scientific Value: Bridges discovery and preclinical validation by ensuring accurate procedural execution in disease-relevant spinal deformity models.
- Operational Value: Enhances translational continuity by allowing consistent replication of surgical techniques across research sites.
Pipeline & Workflow Integration
The system integrates into the preclinical research continuum by enabling reliable surgical intervention in spinal models, supporting progression from target validation to efficacy testing in orthopedic and neurological applications.
- Discovery Biology: Supports hypothesis-driven research requiring precise spinal intervention, such as neuroprotection or spinal cord injury models.
- Screening: Ensures accurate and repeatable device or drug delivery to spinal targets, critical for dose-response and safety profiling.
- Analytics: Provides quantifiable spatial accuracy metrics (e.g., screw placement within safe zones) that correlate with functional outcomes.
- Translational Research: Enables consistent surgical intervention in preclinical models of spinal deformity, facilitating biomarker and outcome alignment.
- Enterprise Reuse: The navigation platform can be adapted across multiple spinal procedures, increasing utility beyond single-use applications.
Operational & Enterprise Impact
- Scientific Value: Improves predictive confidence in preclinical spinal studies by minimizing procedural off-target effects.
- Operational Value: Delivers high reproducibility and standardization in complex surgical interventions across laboratories.
- Strategic Value: Reduces biological variability in efficacy studies, supporting more efficient go/no-go decisions in therapeutic development.
- Portfolio Impact: Enables risk-adjusted advancement of spinal-targeted therapies by increasing confidence in on-target delivery.
Implementation Considerations
- Requires expertise in robotic system operation, optical tracking, and spinal anatomy.
- Dependent on intraoperative imaging (fluoroscopy) and preoperative CT imaging for registration.
- Necessitates cross-functional collaboration between surgeons, engineers, and preclinical researchers.
- Adaptation to non-human spinal models may require scaling of fiducial markers and registration protocols.
- Learning curve associated with handpiece orientation and software interface must be addressed for consistent use.
