Comparing Cortical Bone Trajectories for Pedicle Screw Insertion using Robotic Guidance and Three-Dimensional...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Medical Technology

Background:

• Cortical bone trajectories (CBTs) are utilized for spinal stabilization via pedicle screw insertion.
• Surgeons traditionally rely on fluoroscopy or computed tomography (CT)-navigation for pedicle screw placement.
• Robotic technology presents a potential advancement for enhancing screw insertion accuracy.

Purpose of the Study:

• To evaluate the initial clinical experience and accuracy of robotic guidance for pedicle screw insertion using CBTs.
• To compare the outcomes of robot-assisted CBT pedicle screw insertion with CT navigation-guided insertion.

Main Methods:

• A retrospective review of patients undergoing spinal stabilization with posterior approach CBTs using the Mazor X robotic platform.
• Accuracy assessment based on the Ravi Scale (Grade I-IV) for pedicle screw breaches.
• Comparison with a historical cohort that received CT navigation-guided pedicle screw insertion using CBTs.

Main Results:

• Robot-assisted CBT pedicle screw placement in 22 patients resulted in 92 screws inserted with Grade I accuracy and no complications.
• CT navigation-guided CBT pedicle screw insertion in 18 patients yielded 74 screws, with 69 at Grade I and 5 at Grade II accuracy.
• No significant differences were found between the robotic and CT navigation groups in operative time, fluoroscopy time, or radiation dose.

Conclusions:

• Both robotic technology and CT-navigation technology are safe and accurate for pedicle screw insertion using CBTs.
• Robotic guidance provides a viable and accurate method for CBT pedicle screw placement.
• The findings support the integration of robotic assistance in spinal surgery for improved precision.