Visiting Instructor Stanford Univeristy Palo Alto, California, United States
Introduction: Robotic assistance in spine surgery is emerging as an accurate, effective and enabling technology utilized in the treatment of patients with surgical spinal pathology. Robotic systems have a wide range of applications in spine surgery from the planning and execution of spinal instrumentation to intra-operative navigation. The safety and reproducibility of robotic assistance in the placement of pedicle screw instrumentation is still being investigated. We present the accuracy and efficiency of instrumented spinal fusion utilizing an intra-operative robotic guidance system.
Methods: We retrospectively reviewed all cases of spinal instrumentation of the thoracic and lumbo-sacral spine using the Mazor X robotic system (Medtronic Inc, USA), performed at our institution by one surgeon between July 2017 and June 2020. Clinical variables in addition to operative details were recorded. To replicate clinical relevance, screw accuracy was assessed on postoperative antero-posterior and lateral x-rays by two independent neurosurgeons. Wilcoxon Rank test was used to compare time taken to place each screw during the first 20 cases and the cases thereafter.
Results: A total of 28 patients were included. A total of 159 screws were placed using the Mazor X robotic system. The overall mean time for screw placement was 7.8 ± 2.3 minutes and there was a significant reduction in the mean time for screw placement after the 20th case (8.70 min vs. 5.42 minutes, p=0.008). Mean follow-up was 13.0 ± 12.9 months. Instrumentation was highly accurate. No post-operative neurologic deficit or new radiculopathy was noted. No revision surgery was required within the follow-up period.
Conclusion : From this single-center, single-surgeon series we conclude that robot-assisted spine surgery can be safely and efficiently integrated into the operating room workflow, which improves after a learning curve of approximately 20 operative interventions. We found robot-assisted spinal instrumentation to be reliable, safe, effective and highly precise.
