Researchers evaluate robotic and navigation-assisted pedicle screw placement in degenerative spine surgery

The use of robotics and computer navigation in spinal surgery is expanding rapidly. A growing number of hospitals and spine surgeons are embracing the technology, which aims to improve precision, accuracy and predictability, according to Darren R. Lebl, MD, MBA, spine surgeon at the Hospital for Special Surgery (HSS).

He thinks the technologies have reached a tipping point. “I think they’re good enough to dramatically improve what we’re doing in terms of minimally invasive surgery,” said Dr Lebl. “In my own practice, I have seen the benefits for patients in terms of shorter hospital stays, faster mobility, and reduced healing times.”

The main barriers to implementing new technologies include additional operating room (OR) time and concerns about the precise placement of pedicle screws. Many spinal surgeries require the use of equipment such as pedicle screws to stabilize the spine, and precise positioning is essential.

Dr Lebl and his colleagues at HSS launched a study to assess the accuracy of robotic and navigation-assisted technology in screw placement. They also set out to determine the additional time needed in the operating room, noting that there is a learning curve for a surgical team when implementing a new system.

The study, “Robotic and Wireless Navigation-Assisted Pedicle Screw Placement in Adult Degenerative Spine Surgery,” was presented today at the 2021 American Academy of Orthopedic Surgeons (AAOS) Annual Meeting. . The results were also published in The Journal of Spine Surgery in June 2021.

“Our main finding was that the screw positioning was very precise and that the additional time needed to adopt these technologies in practice was low,” noted Dr Lebl. “In our study, the speed of placement of robotic screws showed improvement in the first cases.”

The research focused on 65 adult patients (mean age 59 years) with degenerative lumbar pathology who underwent robotic navigation posterior spinal fusion from June 2019 to July 2020. A total of 364 instrumented pedicle screw implants were planned. robotically. Only one orthopedic surgeon performed the surgeries using the Medtronic Mazor X Stealth Edition system.

Robotics / navigation time in the operating room, screw placement times and positioning times were recorded. After screw placement, all patients underwent intraoperative 3D fluoroscopy and the screw path was compared to a preoperative CT image. The reasons for converting robotic navigation to k-wire or freehand technique have been recorded.

“The study’s spine surgeon had over 10 years of experience and had placed thousands of screws with prior techniques, so he had alternatives if it was determined that robot-assisted placement with a screw would not be possible, “said Fedan Avrumova. , BS, research assistant in the HSS Spine service. “It is important to note that the robot can be a valuable ‘assistant’ but does not replace surgical experience and good judgment.”

The average time per screw placement was 3.6 minutes in robotics versus 3.7 minutes freehand, with a significant reduction in the time between the first 10 and the last 10 cases: 5.5 minutes versus 2.3 minutes. The installation of the robotic navigation system in the operating room showed a reduction in the time between the first 10 and the last 10 cases: 9 minutes against 6 minutes.

“Many spine surgeons recognize the value of the technology, but the concern has been the extra time needed in the operating room,” said Dr. Lebl. “As we went through our study, we found that it saved time in the operating room. The benefits of the technology easily outweigh the additional time required for the early implementation of the system as the precision is unmatched. “

“When we evaluated the results, we found no complications and no revision surgery was necessary,” noted Ms. Avrumova. “The surgical team have learned to use the robot successfully and have become more efficient with robotic implantation compared to conventional minimally invasive and conventional open techniques. In addition, the accuracy was as good, if not better, than open or conventional minimally invasive techniques. , which we confirmed with a 3D imaging study in each patient during surgery. “

“Just a few years ago there were two robots approved by the FDA to help with spine surgery. There are now five or six, ”said Dr Lebl. “Technology is revolutionizing the way we do things, and it’s a very exciting time to be a spine surgeon.”