gms | German Medical Science

Objective: In modern spinal surgery we aim to maximize the patient outcome and minimize trauma to the body during surgery through the use of minimally invasive techniques. Accuracy of pedicle screw fixation greatly affects clinical outcome which accelerates return to full life. Over the past years Intraoperative navigation has advanced and we see significant improvement of accuracy with less postoperative complications. We report here about our clinical experience using the robot-guided screw placement.

Methods: Data were recorded from medical records and CT-data for 101 patients between February 2014 and February 2016 were operated at our institution with a miniature robot (Renaissance, Fa. Mazor Robotics, Israel). The majority of patients had degenerative spinal disease. Others had spondylolisthesis vera, Tumor, Infection or trauma. Screw placement was performed percutaneously with fluoroscopic aid in all patients. Screw accuracy was evaluated by postoperative CT scans according to the Wiesner et al. scale. We assessed age, the American Society of Anesthesiologists Physical Status Classification System of patients (ASA), co-existing diseases, blood loss, radiation, hospital stay, indications, length of surgery and most importantly screw position accuracy.

Results: In two cases and due to referencing problems, we switched to conventional screw placement. 465 screws were inserted percutaneously. In the postoperative CT scans the robot-guided screws showed an ideal position in 97.8 % and an acceptable position in 1.1 % of cases. There was no need of intra- or postoperative screw replacement. There were no new neurological deficits. X-ray exposition and blood loss were reduced significantly compared to freehand technique. The number of older patients, patients with higher ASA and co existing diseases enrolled for spine surgery has increased; for example we report an increase in cement augmentation use due to increase number of patients with osteoporosis. Moreover we report shorter hospital stay, lower revision rate and less complications .There was a steep learning curve regarding operation time and x-ray reduction.

Conclusion: Robot-Guided spinal surgery offers many potential advantages to patients and surgeons including improving the safety of minimally invasive as well as complex surgical procedures, improving the accuracy of spinal instrumentation, and minimizing the use of radiation during surgery. Robot-guided spine surgery utilizes highly accurate, state-of-the-art technology for the treatment of many spinal conditions including degenerative spinal conditions, spine tumors and spinal deformities.