Jordan Lebovic, Maxwell Trudeau, Lefko T Charalambous, Nitya Venkat, Jason Gallina, Jeffrey A Goldstein
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The purpose of this study is to determine if we should be obtaining advanced imaging to confirm the placement of robotic pedicle screws.</p><p><strong>Methods: </strong>This is a single institution retrospective cohort study of patients from May 2022 to July 2023 who underwent lumbar spinal fusion by a high-volume orthopedic spine surgeon at a level 1 metropolitan hospital. All cases used combined robotics and navigation systems for pedicle screw placement and intraoperative 3D imaging for evaluation of screw position. Pedicle screw accuracy was assessed using the Gertzbein and Robbins system (GRS). Acceptable pedicle screw position was defined as GRS A or B.</p><p><strong>Results: </strong>Seventy patients with 354 robotically placed pedicle screws were assessed with intraoperative 3D fluoroscopy. All pedicle screws were placed in either a GRS type A or type B position. Three hundred forty-seven were placed in a GRS A classification (99.2%, 351/354), and 3 were placed in a GRS B classification (0.08% 3/354). No patients had screw-related complications. The average radiation dosage of 3D imaging was 289.7±164.6 mGy.</p><p><strong>Conclusion: </strong>The robotic system places pedicle screws accurately without 3D intraoperative imaging. Given the increased radiation and operative time associated with 3D imaging protocols 3D imaging scans should only be obtained in cases with heightened clinical concern.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Three-Dimensional Fluoroscopic System to Assess Robotically Placed Pedicle Screws: Should We Confirm Robotic Pedicle Screw Placement With Advanced Imaging?\",\"authors\":\"Jordan Lebovic, Maxwell Trudeau, Lefko T Charalambous, Nitya Venkat, Jason Gallina, Jeffrey A Goldstein\",\"doi\":\"10.1097/BSD.0000000000001724\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The purpose of this study is to determine the utility of advanced imaging to confirm the placement of robotic pedicle screws.</p><p><strong>Summary of background data: </strong>With increasing robotic adoption, certain institutions and surgeons have developed protocols for obtaining 3D intraoperative imaging after robotic pedicle screw placement to ensure proper hardware placement. No studies have assessed the utility of these protocols relative to the potential risks of increased radiation exposure and operative time. The purpose of this study is to determine if we should be obtaining advanced imaging to confirm the placement of robotic pedicle screws.</p><p><strong>Methods: </strong>This is a single institution retrospective cohort study of patients from May 2022 to July 2023 who underwent lumbar spinal fusion by a high-volume orthopedic spine surgeon at a level 1 metropolitan hospital. All cases used combined robotics and navigation systems for pedicle screw placement and intraoperative 3D imaging for evaluation of screw position. Pedicle screw accuracy was assessed using the Gertzbein and Robbins system (GRS). Acceptable pedicle screw position was defined as GRS A or B.</p><p><strong>Results: </strong>Seventy patients with 354 robotically placed pedicle screws were assessed with intraoperative 3D fluoroscopy. 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引用次数: 0
摘要
研究设计回顾性队列研究：本研究的目的是确定先进成像技术在确认机器人椎弓根螺钉置入位置方面的效用：随着机器人应用的不断增加，一些机构和外科医生制定了在机器人椎弓根螺钉置入术后获得三维术中成像的方案，以确保硬件的正确置入。目前还没有研究评估这些方案的实用性与增加辐射暴露和手术时间的潜在风险之间的关系。本研究的目的是确定我们是否应该获取先进的成像来确认机器人椎弓根螺钉的放置：这是一项单一机构的回顾性队列研究，研究对象是2022年5月至2023年7月期间在一家一级城市医院接受腰椎融合术的患者，这些患者由一名高容量的骨科脊柱外科医生负责。所有病例均使用机器人和导航系统进行椎弓根螺钉置入，并通过术中三维成像评估螺钉位置。椎弓根螺钉的准确性使用格茨宾和罗宾斯系统（GRS）进行评估。可接受的椎弓根螺钉位置定义为 GRS A 或 B：通过术中三维透视，对70名患者的354枚机器人置入的椎弓根螺钉进行了评估。所有椎弓根螺钉均放置在 GRS A 型或 B 型位置。347例患者的椎弓根螺钉被置于GRS A型位置（99.2%，351/354），3例患者的椎弓根螺钉被置于GRS B型位置（0.08%，3/354）。没有患者出现螺钉相关并发症。3D成像的平均辐射剂量为289.7±164.6 mGy：结论：机器人系统无需三维术中成像即可准确植入椎弓根螺钉。鉴于三维成像方案会增加辐射和手术时间，只有在临床高度关注的病例中才应进行三维成像扫描：证据等级：IV 级。
Three-Dimensional Fluoroscopic System to Assess Robotically Placed Pedicle Screws: Should We Confirm Robotic Pedicle Screw Placement With Advanced Imaging?
Study design: Retrospective cohort study.
Objective: The purpose of this study is to determine the utility of advanced imaging to confirm the placement of robotic pedicle screws.
Summary of background data: With increasing robotic adoption, certain institutions and surgeons have developed protocols for obtaining 3D intraoperative imaging after robotic pedicle screw placement to ensure proper hardware placement. No studies have assessed the utility of these protocols relative to the potential risks of increased radiation exposure and operative time. The purpose of this study is to determine if we should be obtaining advanced imaging to confirm the placement of robotic pedicle screws.
Methods: This is a single institution retrospective cohort study of patients from May 2022 to July 2023 who underwent lumbar spinal fusion by a high-volume orthopedic spine surgeon at a level 1 metropolitan hospital. All cases used combined robotics and navigation systems for pedicle screw placement and intraoperative 3D imaging for evaluation of screw position. Pedicle screw accuracy was assessed using the Gertzbein and Robbins system (GRS). Acceptable pedicle screw position was defined as GRS A or B.
Results: Seventy patients with 354 robotically placed pedicle screws were assessed with intraoperative 3D fluoroscopy. All pedicle screws were placed in either a GRS type A or type B position. Three hundred forty-seven were placed in a GRS A classification (99.2%, 351/354), and 3 were placed in a GRS B classification (0.08% 3/354). No patients had screw-related complications. The average radiation dosage of 3D imaging was 289.7±164.6 mGy.
Conclusion: The robotic system places pedicle screws accurately without 3D intraoperative imaging. Given the increased radiation and operative time associated with 3D imaging protocols 3D imaging scans should only be obtained in cases with heightened clinical concern.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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