When giants talk; robotic dialog during thoracolumbar and sacral surgery

Abstract

Background: Spinal trauma patients treated in a specialized hybrid operating room (OR) using two robotic systems communicating during surgery.

Methods: Retrospective review of patients with thoracolumbar or sacral fractures who underwent surgical fixation between Jan 2017 to Jan 2020 with robotic-guided percutaneous pedicle screw insertion in the specialized hybrid OR with Robotic flat panel 3D C-arm (ArtisZeego) for intraoperative interventional imaging connected with the robotic-guidance platform Renaissance (Mazor Robotics).

Results: Twenty eight surgeries were performed in 27 patients; 23 with traumatic spinal fractures, 4 with multi-level thoracolumbar compression fractures due to severe osteoporosis. Average patient age 49 (range 12-86). Average radiation exposure time 40 s (range 12-114 s). Average radiation exposure dose 11,584 ± SD uGym² (range 4454-58,959). Lumber levels operated on were between T5 and S2 (shortest three vertebras and longest eight vertebras). 235 (range 5-11) trajectories were performed. All trajectories were accurate in all cases percutaneous pedicle screws placement was correct, without breach noted at the pedicle in any of the cases. No major complications reported. In all cases, follow-up X-rays showed adequate fracture reduction with restoration.

Conclusions: Merging of surgical robotics technologies increases patient safety and surgeon and patient confidence in percutaneous spine traumatic procedures.

Keywords: 3D fluoroscopic imaging; Hybrid operating room; Intraoperative imaging; Pedicle screw accuracy; Robotic guidance; Robotic spine surgery.

Fig. 1

A 3D-flouroscopic scan performed by the Artis Zeego imaging robot

Fig. 2

Using the Renaissance robotic system’s proprietary software the vertebras were identified and segmented; screw trajectories were planned in accordance to vertebral anatomy

Fig. 3

Using the Artis Zeego imaging robot another 3D-fluoroscopic scan verified trajectories

Fig. 4

Case 1: 65 Y/O male was admitted with (1) T8 burst fracture due to electrical bicycle accident. (2) The MRI showed no cord injury. (3) The patient had a percutaneous fixation T6-T10 using robotic guidance and 3D intraoperative imaging. The patient had no complications

Fig. 5

Case 2: 39 Y/O male was admitted with (1) Vertical Sheer fracture after fall from height. (2) The patient had a percutaneous fixation L4-S1 using navigation and 3D intraoperative imaging. The patient had no complications

Fig. 6

Case 3: 48 Y/O female with Bechet disease was admitted with (1) multilevel osteoporotic FX due to prolonged steroid use. (2) The patient had a percutaneous augmentation L4*2, L3, T9-12 using robotic guidance and 3D intraoperative imaging. The patient had minimal cement emboli after the procedure