Miniature robotic guidance for spine surgery — introduction of a novel system and analysis of challenges encountered during the clinical development phase at two spine centres

Instrumented spinal fusion surgery is increasingly performed. Breaching of the pedicle occurs in 3–55% of screws; clinically significant screw misplacements occur in 0–7% of all transpedicular screw placements. Several techniques have reduced this incidence but none gained popularity due to cost as well as staff issues. Surgical robots offer distinct added value in accuracy and minimal invasiveness. The aim of this study is to introduce the SpineAssist® ‐ a novel spine surgery miniature robot, to discuss the various reasons that had prevented full success with its use, to identify patients related, technical related, and surgeon related issues, and to offer ways to avoid them.

[1]  G H Barnett,et al.  Application of frameless stereotaxy to pedicle screw fixation of the spine. , 1995, Journal of neurosurgery.

[2]  C Bolger,et al.  Image-guided surgery: applications to the cervical and thoracic spine and a review of the first 120 procedures. , 2000, Journal of neurosurgery.

[3]  N. Glossop,et al.  Computer‐Aided Pedicle Screw Placement Using Frameless Stereotaxis , 1996, Spine.

[4]  D. Simon,et al.  Accuracy Requirements for Image-Guided Spinal Pedicle Screw Placement , 2001, Spine.

[5]  Yongjung Kim,et al.  Can Triggered Electromyograph Thresholds Predict Safe Thoracic Pedicle Screw Placement? , 2002, Spine.

[6]  John J Carbone,et al.  Fluoroscopically Assisted Pedicle Screw Fixation for Thoracic and Thoracolumbar Injuries: Technique and Short-Term Complications , 2003, Spine.

[7]  C. K. Lee,et al.  Segmental Pedicle Screw Fixation in the Treatment of Thoracic Idiopathic Scoliosis , 1995, Spine.

[8]  F. Girardi,et al.  Safety and efficacy of pedicle screw placement for adult spinal deformity with a pedicle-probing conventional anatomic technique. , 2000, Journal of spinal disorders.

[9]  S. Gertzbein,et al.  Accuracy of Pedicular Screw Placement In Vivo , 1990, Spine.

[10]  L. Holly.  Image‐guided spinal surgery , 2006, The international journal of medical robotics + computer assisted surgery : MRCAS.

[11]  G B Jacobs,et al.  Evaluation with evoked and spontaneous electromyography during lumbar instrumentation: a prospective study. , 1997, Journal of neurosurgery.

[12]  F. Langlotz,et al.  Accuracy of Computer‐Assisted Pedicle Screw Placement: An In Vivo Computed Tomography Analysis , 1997, Spine.

[13]  B. Green,et al.  Computer-assisted Fluoroscopic Targeting System for Pedicle Screw Insertion , 2000, Neurosurgery.

[14]  H Davis,et al.  Increasing Rates of Cervical and Lumbar Spine Surgery in the United States, 1979–1990 , 1994, Spine.

[15]  H Labelle,et al.  Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. , 2000, Spine.

[16]  Kee D. Kim,et al.  Computer-Assisted Thoracic Pedicle Screw Placement: An In Vitro Feasibility Study , 2001, Spine.

[17]  S R Garfin,et al.  Placement of pedicle screws in the thoracic spine. Part II: An anatomical and radiographic assessment. , 1995, The Journal of bone and joint surgery. American volume.

[18]  K Ebmeier,et al.  Intraoperative computerized tomography for improved accuracy of spinal navigation in pedicle screw placement of the thoracic spine. , 2003, Acta neurochirurgica. Supplement.

[19]  L. Nolte,et al.  Improved Accuracy of Pedicle Screw Insertion With Computer-Assisted Surgery: A Prospective Clinical Trial of 30 Patients , 1997, Spine.

[20]  Leo Joskowicz,et al.  Bone-mounted miniature robot for surgical procedures: Concept and clinical applications , 2003, IEEE Trans. Robotics Autom..

[21]  P Merloz,et al.  Pedicle Screw Placement Using Image Guided Techniques , 1998, Clinical orthopaedics and related research.

[22]  D. Polly,et al.  Accuracy of Thoracic Pedicle Screws in Patients with and Without Coronal Plane Spinal Deformities , 2002, Spine.

[23]  T. Laine,et al.  Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients , 2000, European Spine Journal.

[24]  D. E. Casey Jones,et al.  Accuracy of Pedicle Screw Placement in Lumbar Fusions by Plain Radiographs and Computed Tomography , 1995, Spine.

[25]  S Lavallée,et al.  Medical imaging and registration in computer assisted surgery. , 1998, Clinical orthopaedics and related research.

[26]  Maurice M. Smith,et al.  Image-guided spine surgery. , 1996, Neurosurgery clinics of North America.

[27]  V K Goel,et al.  Epidemiology introduction. 1995 Focus Issue Meeting on Fusion. , 1995, Spine.

[28]  Charles Kuntz,et al.  Accuracy of Thoracic Vertebral Body Screw Placement Using Standard Fluoroscopy, Fluoroscopic Image Guidance, and Computed Tomographic Image Guidance: A Cadaver Study , 2003, Spine.

[29]  A. Dhawan,et al.  In Vivo Accuracy of Thoracic Pedicle Screws , 2001, Spine.

[30]  R. Winter,et al.  Complications associated with pedicle screws. , 1999, The Journal of bone and joint surgery. American volume.

[31]  B. Jaramaz,et al.  Computer Assisted Orthopaedic Surgery: Image Guided and Robotic Assistive Technologies , 1998, Clinical orthopaedics and related research.

[32]  D. Reidy,et al.  Evaluation of electromyographic monitoring during insertion of thoracic pedicle screws. , 2001, The Journal of bone and joint surgery. British volume.

[33]  A Hamadeh,et al.  Computer Assisted Spine Surgery , 1997, Clinical orthopaedics and related research.

[34]  A. Alho,et al.  Accuracy of pedicle screw insertion: A prospective CT study in 30 low back patients , 2005, European Spine Journal.

[35]  H. An,et al.  Placement of pedicle screws in the thoracic spine. Part I: Morphometric analysis of the thoracic vertebrae. , 1995, The Journal of bone and joint surgery. American volume.

[36]  R. Yeasting,et al.  Anatomic Considerations of Pedicle Screw Placement in the Thoracic Spine: Roy‐Camille Technique Versus Open‐Lamina Technique , 1998, Spine.

[37]  A. Vaccaro,et al.  Accuracy of pedicle screw placement with the assistance of lateral plain radiography. , 1996, Journal of spinal disorders.

[38]  H. Halm,et al.  Pedicle Screw Instrumentation of the Thoracic Spine in Idiopathic Scoliosis , 1997, Spine.

[39]  S. Esses,et al.  Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members. , 1993, Spine.

[40]  W. Castro,et al.  Accuracy of Pedicle Screw Placement in Lumbar Vertebrae , 1996, Spine.

[41]  D P McGowan,et al.  Spinal pedicle fixation: reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. , 1990, Spine.

[42]  F. Cammisa,et al.  The placement of lumbar pedicle screws using computerised stereotactic guidance. , 1999, The Journal of bone and joint surgery. British volume.

[43]  Russell H. Taylor,et al.  Medical robotics in computer-integrated surgery , 2003, IEEE Trans. Robotics Autom..

[44]  J. Katz,et al.  Lumbar Spinal Fusions: Surgical Rates, Costs, and Complications , 1995, Spine.

[45]  Branislav Jaramaz,et al.  Computer-Assisted Orthopaedic Surgery , 1998, Proceedings of the IEEE.

[46]  U Weber,et al.  Clinical Relevance of Accuracy of Pedicle Screw Placement: A Computed Tomographic‐Supported Analysis , 1998, Spine.

[47]  K. Vosburgh,et al.  In Vitro Simulation: Early Results of Stereotaxy for Pedicle Screw Placement , 1997, Spine.

[48]  C Ozdoba,et al.  Planning and insertion of pedicle screws with computer assistance. , 1997, Journal of spinal disorders.