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Pedicle screw placement is a common but demanding spinal surgical procedure. The close proximity of the central nervous system and major blood vessels creates serious risk of complications, revision surgeries or morbidity if screws are placed inaccurately.
Robotic spine surgery enables surgeons to reduce these risks through advanced pre-operative planning using 3D images, precise of robotics guidance, and maximum visibility of the surgical area without the need for open surgery. By enabling a highly precise, minimally invasive approach to spine surgery, surgeons can reduce tissue trauma, blood loss, post-operative pain and convalescence.
Robotic spine surgery uses a sophisticated guidance system that includes a surgical arm, 3D camera, and a touch-screen control panel for the surgeon to use during the procedure.
Before the surgery, pre-op analytics are performed using anatomy recognition tools to produce a 3D image of the surgical area. This image allows the surgeon to plan the surgery in advance, including the precise location and angle of each screw.
During the procedure, a 3D camera scans and maps the surface of the surgical area, and this 3D image is combined with fluoroscopic images. These images are used to match the pre-operative plan with the intra-operative anatomy.
Intraop verification uses a 3D camera and software to guide surgical arm into position according to the surgical plan. The camera verifies the position of surgical arm. The surgical arm and drill guide keep tools and implants on target for each trajectory to ensure implants are inserted safely and accurately.
Studies have shown that this robotic surgery technique results in an overall shorter length of stay for minimally invasive spine surgery, 2.6 days less than open freehand procedures enabled by fluoroscopy.
Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions. Spine (Phila Pa 1976) 2017;42(6):353–8
Fan Y, Du J, Zhang J, Liu S, Xue X, Huang Y, Zhang J, Hao D. Comparison of Accuracy of Pedicle Screw Insertion Among 4 Guided Technologies in Spine Surgery. Med Sci Monit. 2017 Dec 16;23:5960-5968.
Studies have also demonstrated a significant reduction in time spent placing screws during surgery. Time to place screws was reduced from a mean of 6.7 +/- 0.9 minutes in navigated procedures to 3.7 +/- 1.8 minutes using this robotic spine surgery technology. Faster surgery results in less time under anaesthesia, which can reduce patient risks.
Khan A, Meyers JE, Yavorek S, et al. Comparing Next-Generation Robotic Technology with 3-Dimensional Computed Tomography Navigation Technology for the Insertion of Posterior Pedicle Screws. World Neurosurg 2019; 123, e474-e481.
Finally, studies showed a significant reduction in deviation of screw placement from preoperative planning with robotic spine surgery as compared to fluoroscopy, from a mean of 2.6mm +/- 0.7 to 1.1mm +/- .4.
Lieberman IH, Hardenbrook MA, Wang JC, Guyer RD. Assessment of pedicle screw placement accuracy, procedure time, and radiation exposure using a miniature robotic guidance system. J Spinal Disord Tech 2012;25(5):241–8