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 (FI) taken, fluoro exposure (FE) time and net operation time.

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.

Introduction

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.