Robotic-assisted cortical bone trajectory (CBT) screws using the Mazor X Stealth Edition (MXSE) system: workflow and tec
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REVIEW ARTICLE
Robotic‑assisted cortical bone trajectory (CBT) screws using the Mazor X Stealth Edition (MXSE) system: workflow and technical tips for safe and efficient use John A. Buza III1 · Christopher R. Good2 · Ronald A. Lehman Jr.3 · John Pollina4 · Richard V. Chua5 · Avery L. Buchholz6 · Jeffrey L. Gum1 Received: 29 April 2020 / Accepted: 22 September 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract Robotic-assisted spine surgery has a number of potential advantages, including more precise pre-operative planning, a high degree of accuracy in screw placement, and significantly reduced radiation exposure to the surgical team. While the current primary goal of these systems is to improve the safety of spine surgery by increasing screw accuracy, there are a number of technical errors that may increase the risk of screw malposition. Given the learning curve associated with this technology, it is important for the surgeon to have a thorough understanding of all required steps. In this article, we will demonstrate the setup and workflow of a combined navigation and robotic spine surgery platform using the Mazor X Stealth Edition (MXSE) system to place cortical-based trajectory (CBT) screws, including a review of all technical tips and pearls to efficiently perform this procedure with minimal risk of screw malposition. In this article, we will review surgical planning, operating room setup, robotic arm mounting, registration, and CBT screw placement using the MXSE system. Keywords Robotic surgery · Spine · Workflow · Technique · Mazor X
Introduction In 2001, Mazor Robotics began work on a small spinemounted robot which could assist with pedicle screw instrumentation [1]. In 2004, the first generation of this technology, called Spine Assist, was FDA-approved for clinical use John A. Buza III and Jeffrey L. Gum have contributed equally to this work. * Jeffrey L. Gum [email protected] 1
Department of Spine Surgery, Norton Leatherman Spine Center, 210 E. Gray St. Suite 900, Louisville, KY 40202, USA
2
Virginia Spine Institute, Reston, VA, USA
3
Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
4
Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
5
Northwest Neurospecialists, Tuscon, AZ, USA
6
Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
[2, 3]. This robot-assist platform was small, spine-mounted which had an attached arm with six degrees of freedom, which provided the trajectory for pedicle screw instrumentation. The surgeon could then perform all instrumentation through this guided trajectory. Mazor Robotics released the second generation, termed the Renaissance, in 2011, and followed with the release of the third generation Mazor X in 2016 [4, 5]. The most recent version was first utilized in January of 2019 and it combines navigation and robotics into a single platform called the Mazor X Stealth Edition (MXSE) [6]. Mazor roboti
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