Robotic assisted spine surgery was a breakthrough in the evolution of spinal surgery, gradually gaining its place as an alternative technique for conventional spinal procedures. As the general population's life expectancy increased so does the incidence of spinal pathology and with it emerged an urging need for a safer and more accurate means of treatment. In our institute we apply the “Spine Assist” platform for a variety of spinal procedures as Vertebroplasties, biopsies, Pedicular screws insertion and an inter-vertebral fusion – GOLIF procedures. This study is designed to analyze the learning curve of each procedure, regarding the amount of fluoro images ( All spinal procedures using the “Spine Assist” platform were included in this study; all took place from 2006 until September 2010. Exclusion criteria were procedures with failed pre-op registration, and robotic assisted procedures that were converted to conventional fluoroscopic assisted during the operation. Every single surgery of all types of procedures was analyzed regarding the amount of FI taken, FE time and net operation time. Pedicular screws insertion was grouped into sets of four, where the same parameters were evaluated. Altogether we preformed 106 robotic assisted Vertebroplasty procedures. During this period a distinct learning curve was observed and analyzed. For the first ten Vertebroplasties an average of 12 FI were taken with a net operation time of 53.6 min per procedure. Analyzing the first 40 procedures has shown less FI per procedure (5 FI) and a net operation time of 48.6 min/procedure. Data drawn from the 51 following Vertebroplasties has set the standards of 4 FI with a net operation time of 25.6 min/procedure. Two Vertebroplasty procedures were not completed due to failure of software registration. Pedicular screws are a mean for stabilization of vertebral motion units. During a six years period 706 screws were inserted, out of whom 98 were inserted using percutaneous technique. Comparing the insertion of a set of 4 screws we found a significant improvement regarding the number of FI, FE time and the net operation time between the first ten procedures and the rest with a mean of 20 FI /4 FI and net screw insertion time of 82 min/ 25 min respectively. We found no difference in the parameters comparing percutaneous Vs open Pedicular screws insertion. The mean accuracy of all procedures was 0.3 mm compared to the pre planned screw trajectory. No false route was detected in any of the 506 procedures. This robotic assisted technique is a new and safe approach aiming to shorten the duration of the procedure, thus reducing the patient and surgeon exposure to radiogenic dose. The essence of robotic assisted surgery is a pre planned needle/screw trajectory aiming to reduce the possible intra-operative complication, inaccuracies and possible mishaps emerging during “free hand” procedures. Gaining more experience using the spine assist platform, as shown in this detailed learning curve, enabled us to leverage the platform for ultra-accurate procedures as the percutaneous intervertebral fusion – GOLIF, Vertebroplasty for burst fractures etc.
Our clinic has started to use MAZOR's Spine-Assist(r) robotic device in routine spinal surgery practice since 2006. The use of this system is diverse and now applicable for Vertebroplasty, Biopsy procedures and different techniques of Spinal fusion. During this time our clinic performed near 150 robotic assisted surgeries. Amongst its benefits the system allows the reduction of the duration of fluoroscopic exposure in the OR, better accuracy due to computerized assisted planning and navigation, avoidance of human caused complications and a less traumatic procedure for the patient. On the other hand, the duration of the procedure is prolonged, the wound is subdued to a longer exposure in cases of the open surgery, and the operational cost is higher and requires a good trained medical staff. In the last 2 years we have performed 56 robotic assisted Vertebroplasty procedures (research group). At the same time we have performed 44 non assisted Vertebroplasty procedures. There was a significant difference in the fluoroscopic time and subsequent exposure time to radiation between the groups: in the research group we used only an average of 3 seconds of staff fluoroscopic exposure (an average of 5 fluoroscopic images) compared to an average of 11 seconds of exposure (an average of 24 fluoroscopic images). Furthermore, we have successfully inserted more than 400 pedical screws with less than 1mm accuracy from planning, out which only 8 were misplaced. Subsequently we have also performed 16 biopsies, which were effective as CT based biopsies. The average duration of a surgical procedure without the use of the system in 1 level fusion was 82 min. With the use of the system the average time was 106 min. The operational cost with the use of the system was about 1,000 ∊ more expensive. Furthermore, the use of the system required performing of an additional CT scan with 1 mm slices, which caused an additional exposure to patient radiation.Introduction
Materials and Methods
Vertebral compression fractures can affect both sexes and constitute a major health care problem, due to negative impact on the patient’s function, quality of life and the costs to the health care system. Patients can be treated conservatively or by conventional fluoroscopic assisted vertebroplasty – injection of polymethylmethacrylate PMMA into the fractured vertebral body. Conventional vertebroplasty imposes technical challenges with possible complications including cement extravasations, nerve root compression, the possibility of breaching the walls of the pedicle by the osteoplasty needle and prolonged fluoroscopic radiation exposure of the surgeon and the medical team at large. We present here a comparative study of 20 cases of thoraco-lumbar vertebral compression fracture, treated with robotic assisted vertebroplasty (research group) versus 30 cases of fractures treated by conventional fluoroscopic vertebroplasty (compared group). All patients were diagnosed as suffering from acute vertebral compression fractures (up to 3 weeks from the traumatic event) and were scored 7 and above in the VAS. The mean overall operation time of the fluoroscopic assisted vertebroplasty was 35 minutes compared to a mean operation time of 45 minutes at the robotic assisted vertebroplasty. There was a significant difference in the fluoroscopic time and subsequent exposure time to radiation between the groups: in the research group we used only an average of 3 seconds of fluoroscopic exposure (an average of 5 fluoroscopic images) compared to an average of 7 seconds of exposure (an average of 12 fluoroscopic images). No difference was found between the groups in regard with overall admission time or with the time between the operation and physiotherapy.
Anterior decompression and adequate spine fixation in patients with cervical radiculopathy and myelopathy are essential for functional restoration of cervical spine. In this study, we performed evaluation and comparative radiological assessment of several types of spinal implants in terms of bone block formation, sagittal alignment and effectiveness as a structural support.
Group1. Autograft – 91 patients Group 2. TiNi alloy cages – 74 patients. Group 3. Varilift expandable cages without plate fixation – 22 patients Group 4. Verilift cages with plate fixation – 8 patients Group 5. Bone substitute spacer and plate fixation – 3 patients.
