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Original article
peer-reviewed

Retrospective Review on Accuracy: A Pilot Study of Robotically Guided Thoracolumbar/Sacral Pedicle Screws Versus Fluoroscopy-Guided and Computerized Tomography Stealth-Guided Screws



Abstract

Introduction

Pedicle screw insertion is the mainstay of thora­cic and lumbosacral posterior spinal instrumentation. However, it may be associated with complications such as screw mal­positioning. The purpose of this study was to develop a pilot study to compare the accuracy of robot-guided screw insertion versus hand-guided screw placement for spinal instrumentation. The hand-guided screws were placed with assistance from computerized tomography (CT) stealth guidance or fluoroscopy.

Materials and methods

A retrospective analysis of medical records was done for all patients that had pedicle screw insertion for instrumentation between the dates of December 2013 and January 2016 with post-screw placement CT imaging. The analysis was conducted on screw accuracy between the two categories based on the Gertzbein-Robbins classification.

Results

A total of 49 screws were analyzed for accuracy in six patients. There was no statistically significant difference between the accuracy of hand-placed pedicle screws versus the robotically placed screws (p = 0.311). There was no statistically significant difference in blood loss (p = 0.616), length of procedure (p = 0.192), or post-operative length of stay (p = 0.587).

Conclusion

The findings of our pilot study agree with most prior studies that there was no statistically significant difference in the accuracy of pedicle screw placement between the two methods of screw placement. Therefore, the techniques are equivocal in accuracy. The new technology (robotic-guidance) is as safe as conventional techniques for screw placement. Just like in any surgery, the technique preference should remain surgeon dependent. The results are only from a small sample size in the development of a pilot study so a strong reliance on the data would not be suggested. The study was a preliminary study that will be used as a template and learning process to create a future prospective study to investigate CT stealth and robotically guided screw placement versus “free hand” guided screws.



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Original article
peer-reviewed

Retrospective Review on Accuracy: A Pilot Study of Robotically Guided Thoracolumbar/Sacral Pedicle Screws Versus Fluoroscopy-Guided and Computerized Tomography Stealth-Guided Screws


Author Information

Brian Fiani

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Syed A. Quadri Corresponding Author

Neurosurgery, California Institute of Neurosciences

Vivek Ramakrishnan

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Blake Berman

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Yasir Khan

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Javed Siddiqi

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca


Ethics Statement and Conflict of Interest Disclosures

Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Original article
peer-reviewed

Retrospective Review on Accuracy: A Pilot Study of Robotically Guided Thoracolumbar/Sacral Pedicle Screws Versus Fluoroscopy-Guided and Computerized Tomography Stealth-Guided Screws


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Original article
peer-reviewed

Retrospective Review on Accuracy: A Pilot Study of Robotically Guided Thoracolumbar/Sacral Pedicle Screws Versus Fluoroscopy-Guided and Computerized Tomography Stealth-Guided Screws

  • Author Information
    Brian Fiani

    Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

    Syed A. Quadri Corresponding Author

    Neurosurgery, California Institute of Neurosciences

    Vivek Ramakrishnan

    Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

    Blake Berman

    Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

    Yasir Khan

    Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

    Javed Siddiqi

    Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: July 06, 2017

    DOI

    10.7759/cureus.1437

    Cite this article as:

    Fiani B, Quadri S A, Ramakrishnan V, et al. (July 06, 2017) Retrospective Review on Accuracy: A Pilot Study of Robotically Guided Thoracolumbar/Sacral Pedicle Screws Versus Fluoroscopy-Guided and Computerized Tomography Stealth-Guided Screws. Cureus 9(7): e1437. doi:10.7759/cureus.1437

    Publication history

    Received by Cureus: June 05, 2017
    Peer review began: June 14, 2017
    Peer review concluded: June 15, 2017
    Published: July 06, 2017

    Copyright

    © Copyright 2017
    Fiani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction

Pedicle screw insertion is the mainstay of thora­cic and lumbosacral posterior spinal instrumentation. However, it may be associated with complications such as screw mal­positioning. The purpose of this study was to develop a pilot study to compare the accuracy of robot-guided screw insertion versus hand-guided screw placement for spinal instrumentation. The hand-guided screws were placed with assistance from computerized tomography (CT) stealth guidance or fluoroscopy.

Materials and methods

A retrospective analysis of medical records was done for all patients that had pedicle screw insertion for instrumentation between the dates of December 2013 and January 2016 with post-screw placement CT imaging. The analysis was conducted on screw accuracy between the two categories based on the Gertzbein-Robbins classification.

Results

A total of 49 screws were analyzed for accuracy in six patients. There was no statistically significant difference between the accuracy of hand-placed pedicle screws versus the robotically placed screws (p = 0.311). There was no statistically significant difference in blood loss (p = 0.616), length of procedure (p = 0.192), or post-operative length of stay (p = 0.587).

Conclusion

The findings of our pilot study agree with most prior studies that there was no statistically significant difference in the accuracy of pedicle screw placement between the two methods of screw placement. Therefore, the techniques are equivocal in accuracy. The new technology (robotic-guidance) is as safe as conventional techniques for screw placement. Just like in any surgery, the technique preference should remain surgeon dependent. The results are only from a small sample size in the development of a pilot study so a strong reliance on the data would not be suggested. The study was a preliminary study that will be used as a template and learning process to create a future prospective study to investigate CT stealth and robotically guided screw placement versus “free hand” guided screws.



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Create a free account to continue reading this article.

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Brian Fiani

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Syed A. Quadri

Neurosurgery, California Institute of Neurosciences

For correspondence:
dr.saqader@gmail.com

Vivek Ramakrishnan

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Blake Berman

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Yasir Khan

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Javed Siddiqi

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Brian Fiani

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Syed A. Quadri

Neurosurgery, California Institute of Neurosciences

For correspondence:
dr.saqader@gmail.com

Vivek Ramakrishnan

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Blake Berman

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Yasir Khan

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca

Javed Siddiqi

Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca