Initial intraoperative experience with robotic-assisted pedicle screw placement with stealth navigation in pediatric spi
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ORIGINAL ARTICLE
Initial intraoperative experience with robotic‑assisted pedicle screw placement with stealth navigation in pediatric spine deformity: an evaluation of the first 40 cases Derek Gonzalez1 · Semhal Ghessese1 · Danielle Cook1 · Daniel Hedequist1 Received: 9 June 2020 / Accepted: 9 October 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract Pedicle screw fixation in pediatric spine surgery has become common practice given the fixation stability and improved curve correction. However, due to proximity to vital structures, accuracy is paramount. Literature has reported accuracy rates from 87.5 to 90% using traditional freehand techniques. This study presents our initial experience with pedicle screw placement using the newest generation of spinal robotics for treatment of pediatric spinal deformity. A cohort of patients, aged 8–21 years, undergoing spinal fusion surgery using robotic-assisted technology was reviewed. Diagnoses, Cobb angles, surgical time, robot time, number of screws placed, and complications were recorded. Accuracy of screw placement was assessed based on analysis of successful screw execution, evaluation screw position using intraoperative fluoroscopy and post-operative radiographs, and clinical evaluation. The average age was 14.5 years. Prevalent diagnoses included idiopathic (65%) and neuromuscular scoliosis (13%). Mean preoperative curve measured 66.8°. The median time for operation was 235 minutes with medians of 8 levels fused and 5 screws placed per patient. Of the 314 screws placed, we recorded a 98.7% accuracy rate. Lateral deviation was the most common cause of malpositioning. Post-operative plain films revealed no grossly misplaced screws. There were no perioperative neurologic deficits or malpositioned screws requiring reoperation. This is the first reported series of navigated spinal robotics used for pedicle screw placement in children. Our clinical success rate was 98.7% and there were no clinically relevant screw related complications. The study shows promising initial results of combined robotic-navigation techniques in pediatric patients. Keywords Scoliosis · Spine surgery · Robotic navigation · Pediatric deformity · Cobb angle · Mazor robot
Introduction Robotic-assistance is utilized in almost every surgical specialty as the medical world continues to embrace technological advancements in the modern era [1]. In certain areas of surgery, robotics has become widely implemented for use in most common procedures. However, the role of robotics is less clearly defined in spine surgery which historically has led to delays in its widespread adoption. Despite delays, robotics has established a preliminary role for guiding pedicle screw placement to maximize accuracy and precision. Safe and efficient pedicle screw insertion is especially * Derek Gonzalez [email protected] 1
Department of Orthopedic Surgery, Boston Children’s Hospital/Harvard Medical School, Boston, MA, USA
appealing to spine surgeons performing multilevel deformity correc
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