Artikel
Usability and accuracy of a table mounted, navigated robotic arm for pedicle screw placement
Genauigkeit und Anwendbarkeit eines OP-Tisch-basierten, navigierbaren robotischen Haltearms zur Platzierung von Pedikelschrauben
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Autoren
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Jason Perrin
- Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
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Mirko Arp
- Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
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Gregory Ehrlich
- Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
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Hugo Andrade-Barazarte
- Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
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Frederik Enders
- Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
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Ali Karakoyun
- Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
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Daniel Hänggi
- Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Navigation systems for the placement of pedicle screws are becoming a standard applied technology in spinal surgery. Common practice is to access the pedicle with a navigated hand-held drill guide. The development of robotic and semi-robotic systems is increasing rapidly to further improve the accuracy of pedicle screw placement. In this study we analyzed the usability and precision of a table mounted, navigated robotic Arm for placement of pedicle screws in thoracic and lumbo-sacral spine.
Methods: The robotic arm was mounted to the OR table with a maximum distance of 30 cm to surgical site. After installation of the navigation all pedicle screws were placed with the arm and its integrated navigated drill guide. The robotic arm was manually placed and mechatronically locked over each pedicle entry point. Pedicle screws were planned virtually first, followed by a navigational placement of the actual screws. Images of the virtually planned screws and definite screw positions in postoperative scans were then compared by transparent image overlay to evaluate the accuracy of the navigated robotic arm.
Results: A total of 286 screws were placed with the navigated robotic arm. 204 of these screws were placed in the lumbo-sacral and 82 in the thoracic spine. A mean lateral deviation of 0.3 mm of intra-pedicular screw confinement after comparing the virtual plans to the definite screw positions was detected. Surgery times were extended on average by 8.4 minutes of average due to table mounting and referencing. 2 pedicle screws had to be placed with the hand-held navigated drill guide due patient anatomy and the metrics of the robotic arm. Due to the small dimensions of the arm no OR infrastructural limitations were detected. There were also no complications associated with neither the robotic arm nor its integrated drill guide.
Conclusion: This table mounted robotic arm with integrated navigated drill guide used in this study proves to be highly accurate for the placement of pedicle screws consequently providing the needed sturdiness for precise placement although only small dimensioned. The unit seems to offer advantages for cases with challenging anatomy, e.g. very narrow pedicles. Further comparative analysis to screws placed with hand-held navigated drill guide is still required to prove its possible superiority.
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