Robot-assisted three column trans-intervertebral osteotomy by combined navigated trajectories: A feasibility study...

Area of Science:

• Spinal surgery
• Robotic surgery
• Surgical navigation

Background:

• Spinal osteotomy is crucial for correcting malalignment and deformity.
• Current methods rely heavily on surgeon experience for osseous resection.
• Navigation and robotics offer potential for enhanced precision in spinal procedures.

Purpose of the Study:

• To evaluate if an innovative combined navigated trajectory (CNT) design, utilizing a spinal robot, can achieve precise 3-column osteotomy.
• To assess the accuracy and feasibility of robot-assisted spinal osteotomy.

Main Methods:

• The Mazor X Stealth Edition (MXSE) robotic system was employed to design and perform type II trans-intervertebral osteotomy (TIO) using CNT.
• Preoperative CT imaging of synthetic and cadaveric spine models was used for multitrajectory planning.
• The workflow involved robotic setup, bone fixation, registration, robotic drilling, and osteotomy completion with a chisel.

Main Results:

• Successful registration of osteotomy vertebrae was achieved in both synthetic and cadaveric models.
• Complete TIO was accomplished through multitrajectory drilling and chisel combination.
• Deviation from the preoperative plan was minimal (<2 mm), with small length and angle differences observed.

Conclusions:

• Combined navigated trajectory spinal resection using the MXSE system is a viable technique for quantitative spinal osteotomy.
• Further biomechanical and clinical studies are necessary to confirm the safety and efficacy of this robotic approach.