Guideline for Thoracolumbar Pedicle Screw Placement Assisted by Orthopaedic Surgical Robot

Overview

Journal Orthop Surg

Specialty Orthopedics

Date 2019 Apr 27

PMID 31025807

Citations 25

Authors

Wei Tian

Ya-Jun Liu

Bo Liu

Da He

Jing-Ye Wu

Xiao-Guang Han

Jing-Wei Zhao

Ming-Xing Fan

Affiliations

Soon will be listed here.

Abstract

The pedicle screw placement procedure is the most commonly used technique for spinal fixation and can provide reliable three-column stabilization. Accurate screw placement is necessary in clinical practice. To avoid screw malposition, which may decrease the stiffness of the screw-rod construct or increase the likelihood of neural and vascular injuries, the surgeons must fully understand the regional anatomy. Deformities, such as scoliosis, kyphosis or congenital anomalies, may complicate the application of the pedicle screw placement technique and increase the chance of screw encroachments. Incidences of pedicle screw malposition vary in different districts and hospitals and with surgeons and techniques. Today, the minimally invasive spinal surgery is well developed. However, the narrow corridors and limited views for surgeons increase the difficulty of pedicle screw placement and the possibility of screw encroachment. Evidenced by previous studies, robotic surgery can provide accurate screw placement, especially in settings of spinal deformities, anatomical anomalies, and minimally invasive procedures. Based on the consensus of consultant specialists, the literature review and our local experiences, this guideline introduces the robotic system and describes the workflow of robot-assisted procedures and the precautions to take during procedures. This guideline aims to outline a standardized method for robotic surgery for thoracolumbar pedicle screw placement.

Citing Articles

Comparison of accuracy of pedicle screw placement for adolescent idiopathic scoliosis using freehand fluoroscopic, navigation, and robotic-assisted techniques - a systematic review and bayesian network meta-analysis.

Lajczak P, Ayesha A, Jabbar R, Silva Y, Sharma E, Sahin O Neurosurg Rev. 2025; 48(1):257.

PMID: 39982552 DOI: 10.1007/s10143-025-03333-3.

Analysis of guide wire displacement in robot-assisted spinal pedicle screw implantation.

Liu Q, Wang R, Ru N, Wu Y, Guo C, Chen L J Robot Surg. 2024; 18(1):138.

PMID: 38554242 PMC: 10981612. DOI: 10.1007/s11701-024-01876-z.

Impact of optical navigation variables on the accuracy of robot-assisted surgery: a study of the TIANJI Robot system.

Shi Z, Li Z, Fan M, Wang Q, Liu B, Lang Z J Robot Surg. 2024; 18(1):36.

PMID: 38231441 DOI: 10.1007/s11701-023-01784-8.

Artificial Intelligence in Scoliosis: Current Applications and Future Directions.

Zhang H, Huang C, Wang D, Li K, Han X, Chen X J Clin Med. 2023; 12(23).

PMID: 38068444 PMC: 10707441. DOI: 10.3390/jcm12237382.

Minimally invasive percutaneous screw internal fixation under robot navigation for the treatment of a hamate bone fracture.

Jie F, Hui Z, Dawei Z, Guiqian L, Rongjian S, Weiya Q BMC Musculoskelet Disord. 2023; 24(1):929.

PMID: 38041112 PMC: 10691140. DOI: 10.1186/s12891-023-06917-6.

References

Jutte P, Castelein R . Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J. 2003; 11(6):594-8. DOI: 10.1007/s00586-002-0469-8. View

Katonis P, Christoforakis J, Kontakis G, Aligizakis A, Papadopoulos C, Sapkas G . Complications and problems related to pedicle screw fixation of the spine. Clin Orthop Relat Res. 2003; (411):86-94. DOI: 10.1097/01.blo.0000068761.86536.1d. View

BOUCHER H . A method of spinal fusion. J Bone Joint Surg Br. 1959; 41-B(2):248-59. DOI: 10.1302/0301-620X.41B2.248. View

Kim C, Lee Y, Taylor W, Oygar A, Kim W . Use of navigation-assisted fluoroscopy to decrease radiation exposure during minimally invasive spine surgery. Spine J. 2008; 8(4):584-90. DOI: 10.1016/j.spinee.2006.12.012. View

Barnes A, Eguizabal J, Acosta Jr F, Lotz J, Buckley J, Ames C . Biomechanical pullout strength and stability of the cervical artificial pedicle screw. Spine (Phila Pa 1976). 2009; 34(1):E16-20. DOI: 10.1097/BRS.0b013e3181891772. View

Verma R, Krishan S, Haendlmayer K, Mohsen A . Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws. Eur Spine J. 2010; 19(3):370-5. PMC: 2899753. DOI: 10.1007/s00586-009-1258-4. View

Devito D, Kaplan L, Dietl R, Pfeiffer M, Horne D, Silberstein B . Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976). 2010; 35(24):2109-15. DOI: 10.1097/BRS.0b013e3181d323ab. View

Kantelhardt S, Martinez R, Baerwinkel S, Burger R, Giese A, Rohde V . Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J. 2011; 20(6):860-8. PMC: 3099153. DOI: 10.1007/s00586-011-1729-2. View

Lieberman I, Hardenbrook M, Wang J, Guyer R . Assessment of pedicle screw placement accuracy, procedure time, and radiation exposure using a miniature robotic guidance system. J Spinal Disord Tech. 2011; 25(5):241-8. DOI: 10.1097/BSD.0b013e318218a5ef. View

10.

Gelalis I, Paschos N, Pakos E, Politis A, Arnaoutoglou C, Karageorgos A . Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J. 2011; 21(2):247-55. PMC: 3265579. DOI: 10.1007/s00586-011-2011-3. View

11.

Hartl R, Lam K, Wang J, Korge A, Kandziora F, Audige L . Worldwide survey on the use of navigation in spine surgery. World Neurosurg. 2012; 79(1):162-72. DOI: 10.1016/j.wneu.2012.03.011. View

12.

Shin B, James A, Njoku I, Hartl R . Pedicle screw navigation: a systematic review and meta-analysis of perforation risk for computer-navigated versus freehand insertion. J Neurosurg Spine. 2012; 17(2):113-22. DOI: 10.3171/2012.5.SPINE11399. View

13.

Tian W, Liu Y, Zheng S, Lv Y . Accuracy of lower cervical pedicle screw placement with assistance of distinct navigation systems: a human cadaveric study. Eur Spine J. 2012; 22(1):148-55. PMC: 3540299. DOI: 10.1007/s00586-012-2494-6. View

14.

Spetzger U, von Schilling A, Winkler G, Wahrburg J, Konig A . The past, present and future of minimally invasive spine surgery: a review and speculative outlook. Minim Invasive Ther Allied Technol. 2013; 22(4):227-41. DOI: 10.3109/13645706.2013.821414. View

15.

Lang Z, Tian W, Liu Y, Liu B, Yuan Q, Sun Y . Minimally Invasive Pedicle Screw Fixation Using Intraoperative 3-dimensional Fluoroscopy-based Navigation (CAMISS Technique) for Hangman Fracture. Spine (Phila Pa 1976). 2015; 41(1):39-45. DOI: 10.1097/BRS.0000000000001111. View

16.

Macke J, Woo R, Varich L . Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population. J Robot Surg. 2016; 10(2):145-50. DOI: 10.1007/s11701-016-0587-7. View

17.

Verma K, Boniello A, Rihn J . Emerging Techniques for Posterior Fixation of the Lumbar Spine. J Am Acad Orthop Surg. 2016; 24(6):357-64. DOI: 10.5435/JAAOS-D-14-00378. View

18.

Molliqaj G, Schatlo B, Alaid A, Solomiichuk V, Rohde V, Schaller K . Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus. 2017; 42(5):E14. DOI: 10.3171/2017.3.FOCUS179. View

19.

Tian W, Xu Y, Liu B, Liu Y, He D, Yuan Q . Computer-assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion May Be Better Than Open Surgery for Treating Degenerative Lumbar Disease. Clin Spine Surg. 2017; 30(6):237-242. DOI: 10.1097/BSD.0000000000000165. View

20.

Alaid A, von Eckardstein K, Smoll N, Solomiichuk V, Rohde V, Martinez R . Robot guidance for percutaneous minimally invasive placement of pedicle screws for pyogenic spondylodiscitis is associated with lower rates of wound breakdown compared to conventional fluoroscopy-guided instrumentation. Neurosurg Rev. 2017; 41(2):489-496. DOI: 10.1007/s10143-017-0877-1. View