Article Figures & Data
Figures
- Figure 1
Preoperative pedicle screw trajectory planning at L5 using the ExcelsiusGPS software. The upper left quadrant contains a visual representation of the screw’s placement. The remaining quadrants show the screw’s position from 3 planes of view.
- Figure 2
Gertzbein and Robbins scale (GRS) classification scores are shown on representative computed tomography images; yellow dotted lines indicate the border of the pedicle, and yellow arrows show the distance from screw to pedicle. (A) Grade A, the screw is located completely within the pedicle. (B) Grade B, the screw is mostly within the pedicle, with a slight <2 mm deviation. (C) Grade C, the screw has a pedicle cortical breach of 2 to 4 mm. (D) Grade D, the screw has a 4 to 6 mm pedicle cortical breach. (E) Grade E, the screw is deviated more than 6 mm from the optimal trajectory.
Tables
- Table 1
Demographics and preoperative parameters for 117 patients undergoing robotic spine surgery.
Parameters N (%) Mean ± SD Age, y 60.6 ± 13.2 Sex, male 67 (57%) Race White 84 (72%) African American 28 (24%) Asian 1 (0.8%) Unreported/unknown 4 (3.4%) BMI 29.9 ± 6.4 Smoking status Current 14 (12%) Former 49 (42%) ASA classification 1 2 (1.7%) 2 60 (51%) 3 53 (45%) 4 2 (1.7%) Charlson Comorbidity Index 2.2 ± 2.8 Karnofsky Score ≤40 2 (1.7%) 50–70 56 (48%) ≥80 59 (50%) Frankel Grade A 0 (0%) B 1 (0.8%) C 2 (1.7%) D 66 (56%) E 48 (41%) Indications for surgery Spondylolisthesis 56 (48%) Fracture 12 (10%) Pseudarthrosis 12 (10%) Spondylosis 12 (10%) Tumor 8 (6.8%) Other 17 (15%) Abbreviations: ASA, American Society of Anesthesiologists; BMI, body mass index.
- Table 2
Operative and postoperative parameters for 117 patients undergoing robotic spine surgery.
Parameters N (%) Mean ± SD Total screws 728 Revision surgeries 35 (30%) Operative characteristics Levels operated 3.2 ± 1.7 Estimated blood loss, mL 363 ± 569.1 Incision-to-extubation time, min 222 ± 90.2 Length of stay, d 5.8 ± 7.6 30-d readmission 16 (14%) Screw location Cervical 55 (7.6%) Thoracic 215 (30%) Lumbar 383 (53%) Sacral 75 (10%) Approach Anterior posterior 4 (3.4%) Posterior 113 (97%) Incision Midline 55 (47%) Paramedian 45 (38%) Midline and paramedian 17 (15%) Discharge location Home 93 (79%) ACIR 14 (12%) SAR 10 (8.5%) Reoperation Indication Fusion extension 6 (5.1%) Wound dehiscence 5 (4.3%) Hardware failure 4 (3.4%) Adjacent segment disease 2 (1.7%) Screw revision 2 (1.7%) Radiculopathy 4 (3.4%) Revised screws 3 (0.4%) Complications Wound infection/dehiscence 6 (5.1%) Cerebrospinal fluid leak 6 (5.1%) Other 1 (0.9%) Abbreviations: ACIR, acute inpatient rehabilitation; SAR, subacute rehabilitation.
Level Screw Position GRS Score Revised Total Right Left A B C D E C2 3 4 7 0 0 0 0 0 7 C3 3 3 6 0 0 0 0 0 6 C4 5 5 10 0 0 0 0 0 10 C5 6 6 12 0 0 0 0 0 12 C6 7 7 14 0 0 0 0 0 14 C7 3 3 6 0 0 0 0 0 6 T1 6 6 10 1 0 1 0 0 12 T2 8 8 15 1 0 0 0 0 16 T3 7 7 12 2 0 0 0 0 14 T4 7 7 10 2 2 0 0 0 14 T5 6 6 10 1 1 0 0 0 12 T6 5 5 8 0 1 1 0 0 10 T7 5 5 10 0 0 0 0 0 10 T8 7 6 11 1 1 0 0 0 13 T9 7 7 13 0 1 0 0 0 14 T10 15 15 24 4 2 0 0 0 30 T11 19 19 34 1 3 0 0 0 38 T12 16 16 29 0 1 2 0 1 32 L1 16 16 27 3 2 0 0 0 32 L2 19 19 32 4 2 0 0 0 38 L3 31 31 55 3 4 0 0 1 62 L4 59 59 109 7 2 0 0 0 118 L5 67 66 131 1 0 0 1 1 133 S1 33 32 65 0 0 0 0 0 65 S2AI 5 5 10 0 0 0 0 0 10 Total 365 363 670 (92%) 31 (4.3%) 22 (3%) 4 (0.5%) 1 (0.1%) 3 (0.4%) 728 Abbreviations: AI, alar-iliac; GRS, Gertzbein and Robbins scale.
- Table 4
Patients with pedicle screw breach who underwent revision of malpositioned hardware.
Patient
#Age, y Gender Diagnosis Surgery Performed Screw Levels Reason for Revision Postoperative Outcome 1 68 F Deformity (severe degenerative scoliosis) T4-ilium posterolateral fusion L3 (right) and L5 (right) Patient experienced right leg numbness and weakness. Imaging revealed the right L3 and L5 appeared to have a medial trajectory (both GRS E). Screw reposition was conducted to ensure optimal bony purchase. New screws were GRS A. No postoperative screw-related complications were present. 2 24 F Unstable L1 fracture T12–L2 fusion T12 (right) Intraoperative O-arm imaging revealed the screw was lateral secondary to deflection at the entry site, so a more medial and slightly inferior trajectory was planned. This avoided a steep bone entry point and ensured better bony purchase in the flat portion of the posterior spine. New screw was GRS A. No postoperative screw-related complications were present. Abbreviation: GRS, Gertzbein and Robbins scale.
- Table 5
Stepwise multivariate ordinal logistic regression model of preoperative and surgical variables associated with pedicle screw accuracy.
Variable Univariable Multivariable OR P OR (95% CI) P Age 1.00 0.67 Gender Men 1.89 0.03a b 2.12 (1.10, 4.09) 0.03b Race White 0.61 0.08a 0.39 (0.07, 2.02) 0.26 African American 1.68 0.07a 0.83 (0.16, 4.43) 0.83 Asian 1.53 0.69 Unreported/unknown 0.73 0.76 BMI 0.99 0.81 Cancer 1.37 0.56 Frankel Grade 0.89 0.59 Karnofsky Score 1.39 0.21 CCI 0.99 0.80 ASA status 0.93 0.77 Diagnosis Spondylolisthesis 0.32 0.01a b 0.62 (0.23, 1.69) 0.35 Fracture 0.72 0.34 Pseudarthrosis 2.26 0.02a b 1.51 (0.59, 3.82) 0.39 Spondylosis 0.90 0.83 Tumor 1.34 0.55 Other 1.67 0.08a 0.96 (0.36, 2.57) 0.93 Revision 3.49 <0.001a b 2.43 (1.15, 5.11) 0.02b Screw location Cervical <0.001 0.97 Thoracic 2.62 0.00a b 2.33 (1.22, 4.43) 0.01b Lumbar 0.80 0.42 Sacral 0.26 0.06a 0.33 (0.08, 1.45) 0.14 Approach Posterior 0.46 0.12 Incision Midline 0.98 0.93 Bilateral 1.34 0.30 Both 0.55 0.21 Screw number 1.07 <0.001a b 1.03 (0.96, 1.11) 0.39 EBL 1.00 0.10 Incision-to-extubation time 1.00 0.03a b 1 (0.99, 1.00) 0.15
In this issue
Jump to section
Related Articles
Cited By...
- No citing articles found.