Email: doctor@spinevidya.com
Manipal Institute of Robotic Spine Surgery
Manipal Comprehensive Spine Care Center,
Manipal Hospital, 98, HAL Airport Rd, Kodihalli,
Bengaluru, Karnataka 560017, India
Ph: +918025023334
Clinical Study
Vidyadhara Srinivasa, Balamurugan Thirugnanam, Madhava Pai Kanhangad, Abhishek Soni, Anjana Kashyap, Alia Vidyadhara, Sharath K. Rao
https://doi.org/10.1016/j.jor.2024.06.011
Aims and objectives To determine accuracy of pedicle screws placed by freehand, fluoroscopy-assistance and robotic-assistance with intraoperative image acquisition, and determine the presence of learning curve in robotic spine surgery in a prospective single centre study. Materials and methods In a prospective study, a total of 1120 pedicle screws were placed in Freehand group (n = 175), 1250 screws were placed in fluoroscopy-assisted group (n = 172), and 1225 screws were inserted in Robotic-assisted group(n = 180). Surgical parameters and screw accuracy were analyzed between the three groups. The preoperative plan was overlapped with post operative O-arm scan to determine if the screws were executed as planned. Results The frequency of clinically acceptable screw placement (Gertzbein and Robbins grade A, B) in the Freehand, Fluoroscopy-assisted, and Robotic-assisted groups were 97.7 %, 98.6 %, and 99.34 % respectively. Higher pedicle screw accuracy, and lower blood loss were seen with robotic assistance. There was no significant difference in these parameters between surgeries commencing before and after 2 p.m. We found no statistically significant differences between the planned and executed screw trajectories in robotic assisted group irrespective of surgical experience. Conclusion The third-generation robotic-assisted pedicle screw placement system, used in conjunction with intraoperative 3D O-arm imaging, consistently lowered blood loss and increased accuracy of pedicle screw placement in the thoracolumbar spine. It also has easy adaptability into spine practice with minimal learning curve.
Clinical Study
Madhava Pai Kanhangad, Vidyadhara Srinivasa, Balamurugan Thirugnanam, Abhishek Soni, Anjana Kashyap, Alia Vidyadhara , Sharath Kumar Rao
PMCID: PMC11538820 PMID: 39434223
Study Design Prospective single-center study. Purpose To compare the accuracy of pedicle screws placed by freehand and under fluoroscopy and robotic assistance with intraoperative image acquisition. Overview of Literature Pedicle screws are the most commonly used spinal anchors owing to their ability to stabilize all three spinal columns. Various techniques such as freehand, fluoroscopy-assisted, and navigation-assisted pedicle screw placements have been used with varying degrees of accuracy. Most studies on robotic-assisted pedicle screw placement have utilized preoperatively acquired computed tomography scans. To our knowledge, this is the only study in the literature that compared freehand with fluoroscopy-guided and robotic-assisted pedicle screw insertion with freehand and fluoroscopy. Methods In this prospective study, a total of 1,120 pedicle screws were placed in the freehand group (n=175), 1,250 in the fluoroscopy-assisted group (n=172), and 1,225 in the robotic-assisted group (n=180). Surgical parameters and screw accuracy were analyzed between the three groups. The preoperative plan overlapped with the postoperative O-arm scan to determine if the screws were executed as planned. Results The frequency of clinically acceptable screw placement (Gertzbein-Robbins grades A and B) in the freehand, fluoroscopy-assisted, and robotic-assisted groups were 97.7%, 98.6%, and 99.34%, respectively. With robotic assistance, an experience-neutralizing effect implied that surgeons with varying levels of experience achieved comparable pedicle screw accuracy, blood loss, O-arm time, robot time, and time per screw. No significant difference in these parameters was found between surgeries commencing before and after 2 PM. No significant differences were noted between the planned and executed screw trajectories in the robotic-assisted group irrespective of surgical experience. Conclusions The third-generation robotic-assisted pedicle screw placement system used in conjunction with intraoperative three-dimensional O-arm imaging consistently demonstrates safe and accurate screw placement with an experience-neutralizing effect. Keywords: Thoracolumbar spine, Robotic surgical procedures, Pedicle screws
Case Report
Kanhangad, Madhava Pai; Thirugnanam, Balamurugan; Soni, Abhishek; Srinivasa, Vidyadhara
Indian Spine Journal 7(2):p 209-212, July-December 2024. | DOI: 10.4103/isj.isj_78_23
Sacroplasty is one of the surgical modalities described in the treatment of sacral insufficiency fractures that don’t respond to non-operative treatment. While the percutaneous procedure is generally done under sedation, complications can arise from cement leakage into the spinal canal and sacral foramina. We present a case of Robotic-Assisted Percutaneous Balloon Sacroplasty in a patient with unilateral sacral insufficiency fracture using the MazorX stealth edition. A 55-year-old female presented with a left-sided sacral insufficiency fracture which was not responding to non-operative treatment. She underwent Robotic-Assisted Percutaneous Balloon Sacroplasty using the robotic arm and navigation capabilities of the MazorX stealth edition. About 9 mL of bone cement with hydroxyapatite was injected into the S1 body and left ala. The patient was mobilized post-operatively with minimal pain, 2 h after the procedure. Robotic assistance in percutaneous balloon sacroplasty ensures proper tracks for injection of bone cement with reduced chances of cement leakage.