Robotic-Assisted Pedicle Screw Placement During Spine Surgery

作者：Isador H. Lieberman, Stanley Kisinde, Shea Hesselbacher · 发表于：JBJS Essential Surgical Techniques · 年份：2020 · DOI：10.2106/jbjs.st.19.00020 · 被引用次数：151 · 研究领域：Spinal Fractures and Fixation Techniques、Cervical and Thoracic Myelopathy、Intraoperative Neuromonitoring and Anesthetic Effects

Background: Preoperative planning software and a robotic device facilitate the placement of pedicle screws, especially in patients with difficult anatomy, thereby increasing the feasibility, accuracy, and efficiency of the procedure. The robot functions as a semiactive surgical assistive device whose goal is not to substitute but to offer the surgeon a set of versatile tools that can broaden his or her ability to treat patients 1 . Description: The robotic guidance system consists of a bed-mounted surgical arm and a workstation. We used the Mazor X Stealth Edition Robotic Guidance System by Medtronic for spine surgery, which has been previously described 2–5 . Unlike other systems that are navigation-based and require an optical tracking mechanism, this system relies on the preoperative plan to be referenced using the intraoperative registration. The workstation runs an interface software that facilitates preoperative planning, intraoperative image acquisition and registration, kinematic calculations, and real-time robot motion control. The robotic arm is mounted onto the bed as well as rigidly attached to the patient’s spine. It can move in 6 degrees of freedom to provide the preplanned screw trajectory and entry point thereby allowing the surgeon to manually perform the drilling and screw insertion through either an open or percutaneous procedure by first seating a drill tube and then drilling and tapping the hole as needed. Alternatives: Other robotic systems include the R...