A new study of pedicle screw placement with Mazor Robotics' robotic guidance system reported improved accuracy and reduced exposure to radiation for surgeons.
The study was presented as an e-poster titled "Retrospective, Five-Center Analysis of 3,270 Pedicle Screws Placed with Robotic Guidance in Adolescent Idiopathic Scoliosis (AIS)" at the 21st International Meeting on Advanced Spine Techniques in Spain. The study included 223 patients who underwent surgery at five locations — Texas Back Institute, UCI Irvine Medical Center, Florida Hospital for Children, Children's Healthcare of Atlanta and Apollo Hospital Chennai in India — where surgeons placed 3,270 screws.
Here are five key concepts from the study:
1. Flouroscopy use was limited to 1.58 seconds per screw with the Renaissance system. Per center the average exposure per screw was between 1.12 and 3.73 seconds per screw. The average fluoroscopy use per patient was 30.8±17.9 seconds.
2. The surgeons reported 99 percent accuracy in pedicle screw placement with the Renaissance System. "Anatomic constraints in AIS frequently confound placement of pedicle screws, especially when instrument the most deformed regions of a curved spine," said Dennis P. Devito, MD, of Children's Healthcare of Atlanta and a lead investigator in the study, in a news release. "The accuracy of screw placement and reduced exposure to radiation per case results in safer operations for both the patient and surgical staff."
3. Instrumentation time was 4.5±1.5 minutes per screw, ranging from 3.5 to 7.5 minutes depending on the surgical technique. The surgeons could either drill all pilot holes first and then place the screws after the robot is removed from the surgical field, or they can immediately place screws after drilling each hole.
"Instrumentation times demonstrate that robotic guidance may shorten surgeries and low standard deviations represent consistency regardless of anatomy or technical complexity," concluded the study authors.
4. There were 216 screws were not placed due to the surgeon's intraoperative decision. When accounting for these screws, the execution was 92.2 percent accurate. Additionally, there were 275 screws placed freehand when the robot's software failed to register or due to trajectories beyond the robot's scope.
5. The robot can be used during both minimally invasive and complex spinal surgeries. A large multicenter study of 14 hospitals has around 98 percent accuracy, compared to freehand surgery in the literature where around 10 percent of pedicle screws are misplaced.
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